| NPI | 1215010467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON KENYON SCARR Provider 707-584-1630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 25762) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |