| NPI | 1104634013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER RICH Manager 209-573-0879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist Endodontics | |
| 1223P0221X Dentist Pediatric Dentistry | |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2024-12-23 |