| NPI | 1093865610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAISY GONZAGA ISON Dentist 209-952-2933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 34120) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |