| NPI | 1053964072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CHARLES TRUEB Owner 209-823-3574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2020-08-26 |