| NPI | 1679696645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORMA ICARANGAL Accounting Executive 510-526-6574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 50183) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 46869) |
| 122300000X Dentist (Licence: CA 20885) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 50151) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 20885) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |