| NPI | 1760363832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEANN BLAZER Director Of Operations 707-673-7531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |