| NPI | 1902373640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA L LANDIS Insurance Biller 909-920-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2018-10-31 |