| NPI | 1245511013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED K CORBRIDGE Principal 916-990-4823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2011-09-07 |