| NPI | 1174728224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THIDA MAHASUCON Dentist 209-723-3071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 41901) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 41952) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2020-08-22 |