| NPI | 1902348717 |
|---|---|
| Doing Business As | LAKE FOREST MODERN DENTAL |
| Entity Type | Organization |
| Authorized Contact | SEAN NGUYEN President 949-415-7776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58399) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2016-11-10 |