| NPI | 1952431033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CECILE LICAUCO President 714-994-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 40656) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 41314) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |