Facts
- Status
- A
- Credential
- DDS MS
- Type
- Individual
- Enumeration date
- 2007-11-20
- Last updated
- 2007-11-20
Licenses
- License CA
- 47443
Location
- Practice location
- 451 WEST GONZALES RD, SUITE 320
- City
- OXNARD CA
- Postal code
- 93036
- Phone
- 805-485-5150
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.