| NPI | 1508234766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID TANNER Owner 6612-254-1884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 30463) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2015-09-04 |