| NPI | 1174913578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER ELLIOTT NELSON Owner 707-337-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 56695) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2015-01-23 |