| NPI | 1013514140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA MCQUEEN Director Of Revenue Cycle Managemen 916-444-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |