| NPI | 1396997979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE A. HAVENS Owner 559-448-9870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 46188) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |