| NPI | 1780668020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLENE A MENDIETA Owner 510-724-8441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DA34741) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2008-07-14 |