| NPI | 1043210735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA E HANSEN Owner 805-527-3306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 24506) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 47371) |
| 1223G0001X Dentist, General Practice (Licence: CA 36203) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2020-08-22 |