| NPI | 1487031027 |
|---|---|
| Doing Business As | MYTOOTHSPA DENTISTRY AND ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | ANTHONY ESCANO DEGUZMAN Administartor 916-919-5721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 41390) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA 41390) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |