| NPI | 1447591987 |
|---|---|
| Doing Business As | HERITAGE OAK DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHANE MARK DOUGLAS President 916-626-4050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2021-03-17 |