| NPI | 1003920364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD LEWIS JOHNSON VP 916-967-1199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 46616) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 20209) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-08-22 |