| NPI | 1275089963 |
|---|---|
| Doing Business As | MIDTOWN MODERN DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | SERGIO VICUNA Owner 916-246-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |