| NPI | 1619229200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN L LOUGEE Finance/Insurance 707-522-1059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 23921) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-10-08 |