| NPI | 1164942645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL BALDWIN Practice Administrator 209-823-9371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 51526) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2022-07-21 |