| NPI | 1225860422 |
|---|---|
| Other Name | N/A |
| Entity Type | Organization |
| Authorized Contact | AHMAD REZA EDALATI SHARBAF Dentist/ Owner 916-294-5214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2024-08-15 |