| NPI | 1356654594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAVEENA PERMALLA President 707-773-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 54953) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2010-07-16 |