| NPI | 1144956293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEC TEMLOCK Authorized Official 209-380-5486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2022-07-29 |