| NPI | 1730679747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAULIO ULLOA General Dentist 415-400-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 47673) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100311) |
| 1223G0001X Dentist, General Practice (Licence: CA 101455) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-05-15 |