| NPI | 1104001015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SURYAMANGA D ACHYUTA Dentist 707-778-9993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51889) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2008-01-09 |