| NPI | 1891105540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN BRADLE President 626-290-7106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61315) |
| Enumeration Date | 2014-05-03 |
| Last Update Date | 2014-05-03 |