| NPI | 1992795272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PATRICK DAVIS Owner 760-942-1131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 26834) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 32635) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2020-08-22 |