| NPI | 1912121781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERVIN L ELLSTROM Owner President 951-242-3431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 24928) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2010-01-07 |