| NPI | 1982351771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY GLEN ALLRED Owner 760-304-6455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |