| NPI | 1932772191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE AHN WALLACE President 714-230-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223X2210X Dentist, Orofacial Pain | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-07-23 |