| NPI | 1679878763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI MATULOVICH Office Manager 925-934-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 30346) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 37490) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2018-01-29 |