| NPI | 1750595567 |
|---|---|
| Doing Business As | FRUITVALE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | RICHARD H. MOGENSEN President 510-452-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA CA 21733) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |