| NPI | 1083052054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK BOYES COO 916-570-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2023-02-09 |