| NPI | 1619179629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELEANOR T WARD Office Manager 530-898-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 41959) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 35882) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-08-22 |