| NPI | 1679039960 |
|---|---|
| Doing Business As | LAND PARK MODERN DENTISTRY DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | REYMOND C. BAUTISTA Owner 916-550-9429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2022-08-05 |