| NPI | 1093926842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN R. FONG President 510-581-2142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 38994) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2011-11-04 |