| NPI | 1942603105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUSUMO SUMARDI President 909-596-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 41680) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |