| NPI | 1265200356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE BURUCA Enrollment Coordinator 559-837-1066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-08-05 |