| NPI | 1255520235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JAMES CLARK Owner 805-983-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 39247) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 39247) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CA 39247) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2013-04-11 |