| NPI | 1831496785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERECITA DEAN Owner 510-522-0878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: CA 37095) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 37095) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2011-02-11 |