| NPI | 1710246798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY SUN PARK Dentist/Owner 209-537-4427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CA 41769) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2021-08-03 |