| NPI | 1649677915 |
|---|---|
| Other Name | RIVERSIDE O.S. |
| Entity Type | Organization |
| Authorized Contact | DANIEL W PETERSEN Owner 530-223-1811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 57031) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2014-12-02 |