| NPI | 1548377922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMILO RIAO Owner 415-573-5182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48321) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51643) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 48321) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 51643) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-07-21 |