| NPI | 1902431836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA CARR Office Manager 949-508-2625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2020-03-20 |