| NPI | 1639741150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY C OLSON CEO 559-732-4146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |