| NPI | 1265166789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEN SASO Executive Manager 916-479-3432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-07-11 |