| NPI | 1972270890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY SCOTT PAXMAN President 909-363-5075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-27 |