| NPI | 1790853653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS CHARLES PETRAS Dentist 530-222-2473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 22171) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 22171) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |