| NPI | 1427177815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN EZZATI Dentist 650-949-4734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 37544) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 35491) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |