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NPI 1902243454 · on the registry since 2013
Practice
- Address
- 11200 Corbin Ave # 208
Porter Ranch, CA 91326 - Phone
- (614) 309-1050
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- General Practice Dentistry
1223G0001X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2022-08-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California