| NPI | 1396825766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED D COFFMAN President 916-784-3337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 029142) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |