| NPI | 1033964333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE BURUCA Enrollment Coordinator 559-837-1066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2024-08-05 |