| NPI | 1437591930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE WESLEY MCRAY President/Owner 707-642-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 57025) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |