| NPI | 1235203886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA C BLACK Dentist 510-290-4744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4543) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 4543) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2009-10-21 |