| NPI | 1609385020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSIE ADAME Medical Billing Specialist 408-266-6144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist (Licence: DDS54347) |
| 1223E0200X Dentist Endodontics | |
| 1223P0300X Dentist Periodontics | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2018-05-10 |