NPI: 1922498302 · SAN FERNANDO, CA 91340 · Dentist · NPI assigned 01/23/2015
| Authorized Official | MALLEUS, JERRY (PRES.) |
| NPI Enumeration Date | 01/23/2015 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 14 | $210.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0150 | 14 | 12 | $210.00 |