| NPI | 1871016501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA MASILLAMONI President 410-487-2910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 64723) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2022-07-21 |