| NPI | 1730473034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTY RICHARD LIPSEY President 209-527-1995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 26675) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27009) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-09 |