| NPI | 1982490397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BLACKBURN Owner/Dentist 562-596-7484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| 1223E0200X Dentist, Endodontics | |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 1223G0001X Dentist, General Practice | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2026-03-04 |