| NPI | 1912538810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA PETERSON Owner 909-774-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2023-04-24 |