| NPI | 1407341621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE NIEMIEC Office Manager 510-256-7116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 261QD0000X Clinic/Center Dental (Licence: CA 102443) | |
| 261QD0000X Clinic/Center Dental (Licence: CA 54003) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 61795) | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2018-06-29 |