| NPI | 1659893824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA ANN WARUCH Business Administrator 916-443-8955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 37757) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2022-07-21 |