| NPI | 1699429126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEN SASO Director Of Operations 916-479-3432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2022-02-03 |