| NPI | 1891536249 |
|---|---|
| Former Legal Business Name | RESIDENTAL |
| Entity Type | Organization |
| Authorized Contact | STEFANIE BERTRAM Owner 661-886-3583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2024-06-14 |