| NPI | 1912079187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARACELLY MONTENEGRO Senior Manager 714-578-6358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN8678) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL 3689) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2015-12-16 |