| NPI | 1063572261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY G BOERO Owner 415-454-8640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 219797) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 18450) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |