| NPI | 1780946467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON D MARTIN CEO 916-630-0306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 56921) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 45549) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-06-08 |