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 |