| 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 |