| NPI | 1932308079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEJAS MODI President 951-246-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA D47131) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA D50823) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA D43182) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2007-07-17 |