| NPI | 1962850602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN DERYCK HOOVER President 951-205-5790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 61621) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2016-06-02 |