| NPI | 1952872517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD FARAJZADEH Owner 858-792-6662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2019-10-17 |