| NPI | 1194872499 |
|---|---|
| Doing Business As | PARK AVENUE DENTAL |
| Entity Type | Organization |
| Authorized Contact | MATTHEW C DO Secretary 209-535-3469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 45452) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2008-05-08 |