| NPI | 1073875852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTY RICHARD LIPSEY President 209-380-5486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 26675) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2013-01-15 |