| NPI | 1790063089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA KELLY-GRANATH Secretary 707-528-9411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 32309) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2011-08-03 |