| NPI | 1720392756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ALLEN IVERSON President 530-671-2940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 33473) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2010-08-02 |