| NPI | 1790504298 |
|---|---|
| Doing Business As | SHASTA KIDS DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANDREK JEFFREY INGERSOLL Owner 530-579-1722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |