| NPI | 1447619853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN ANTHONY KELLEHER Owner 209-242-3439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 1578) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |