| NPI | 1548713084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN HAMILTON Aegd Program Director 707-423-7008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030225) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-08-02 |