| NPI | 1952604522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN R WALDER President, Owner 310-413-8899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24486) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |