| NPI | 1386156743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY EDWARD PREWITT Director 559-875-3927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 52566) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101941) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-25 |