| NPI | 1528668746 |
|---|---|
| Doing Business As | SHASTA KIDS DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANDY JEFFREY INGERSOLL Manager 530-579-1722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2021-04-29 |