| NPI | 1184152324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN KEVIN VREEBURG President 707-490-9084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA 63803) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2017-06-01 |