| NPI | 1427485259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY FORE Owner 530-273-1470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 40589) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2015-02-03 |