| NPI | 1376660894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED CARL HAEBERLEIN President 415-441-7766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 25895) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |