| NPI | 1528508488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ALEXANDER Executive Director 209-754-6258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2022-11-17 |