| NPI | 1740011121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEPAND GHANOUNI Chief Financial Officer 916-545-5373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2024-08-08 |