| NPI | 1912226804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES C PARK President 909-610-0565 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50087) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2010-05-18 |