| NPI | 1598568263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUSHBOO KUMAR Credentialing Specialist 916-877-7450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-28 |