| NPI | 1871858688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETICIA CAMACHO Presidenr 714-972-2506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55738) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA 55738) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2012-07-09 |