| NPI | 1104002294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD E GOWANS Owner President 916-782-2161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |