| NPI | 1215239819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BRENT GORRELL Dentist 650-967-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 28559) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2010-12-02 |