| NPI | 1962890632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER M HANAWALT Owner 909-593-4581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |