| NPI | 1790035145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER COREN RE Rda / Front Office Assistant 707-448-6271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 34521) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |