| NPI | 1164032074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE BURUCA Credentialing Coordinator 559-837-1066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2022-07-25 |