| NPI | 1518700822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUSHBOO KUMAR Credentialing Specialist 916-877-7450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-06-14 |