| NPI | 1538551924 |
|---|---|
| Doing Business As | CRESTVIEW DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | KENNETH WALLIS President 408-406-3077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 34914) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2015-02-23 |