| NPI | 1104245398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY CARLSON LOUIE President/Owner 209-478-5616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 32739) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |