| NPI | 1457103905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WILEY Owner 530-223-5040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2024-04-05 |