| NPI | 1245553924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA MARIE BYCROFT Manager 916-783-2110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50724) |
| Enumeration Date | 2010-03-09 |
| Last Update Date | 2010-03-09 |