| NPI | 1992314421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL FUENTES Billing Manger 310-870-9652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |