| NPI | 1336460088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JOHN BLACK Owner 916-331-6288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 40140) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2010-06-17 |