| NPI | 1063987865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES MATTINGLY Owner 925-216-5446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2019-05-29 |