| NPI | 1538761838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE WRIGHT Enrollment Officer 559-578-8274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2025-05-21 |