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 |