| NPI | 1275664484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERISA SUE ELLOWAY Owner 707-442-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 49706) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 47254) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |