| NPI | 1336696426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DMITRIY PIVNIK Officer 415-412-3158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 100181) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2022-10-18 |