| NPI | 1164661773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA SANTOS Dentist, Owner 415-362-9893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 37909) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2021-06-09 |