| NPI | 1629808779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW TANUVASA President 385-216-4421 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health |
| 1223E0200X Dentist, Endodontics | |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-10-01 |