| NPI | 1619169521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J GERVASE Insurance Coordinator 530-223-1811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 19525) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2008-03-25 |