| NPI | 1760312417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY VAN DER GROEN President 925-348-3118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2026-05-22 |
| Last Update Date | 2026-05-22 |