| NPI | 1790866309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE GALE MORENO President, Treas. 209-478-3036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 34387) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54645) |
| 1223P0300X Dentist, Periodontics (Licence: CA 32491) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |