| NPI | 1245628270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDITH IVONNE MORA Dentist 209-462-2452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58214) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53470) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2015-12-02 |