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 |