| NPI | 1952402158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID D WYNN Owner 619-287-8870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA D22569-01) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |