| NPI | 1740672005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK RYDER Program Director 415-476-1699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 64230) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2015-02-24 |