| NPI | 1932503042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAINA BRASLAVSKY Secretary 323-876-0346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 31575) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54801) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |