| NPI | 1013882323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA K SHEPPARD Business Assistant 209-522-9963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-10-07 |
| Last Update Date | 2025-10-07 |