| NPI | 1053557207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON TYLER BALDWIN Treasurer 408-227-0910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 52826) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |