| NPI | 1871147983 |
|---|---|
| Doing Business As | VISTA MODERN DENTISTRY DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | RONNY LE General Dentist/Owner 760-208-1173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2022-03-08 |