| NPI | 1952932055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY LOYOLA Manager 949-771-7381 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |