| NPI | 1730631086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE N PEDERSEN Owner 707-447-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 31510) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64725) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2016-11-02 |