NPI | 1053783779 |
---|---|
Entity Type | Organization |
Authorized Contact | BEVERLY DEFFEBACH Board Member 916-705-6346 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2015-10-21 |
Last Update Date | 2015-10-21 |