| NPI | 1962533919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY ALLEN ELI President 760-436-4062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223X2210X Dentist, Orofacial Pain | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-06-14 |