| NPI | 1912306721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY A EVANS Office Manager 949-496-5713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 29647) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |