| NPI | 1831670090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA J RUSSO Director Of Finance 707-230-5602 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 46245) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2018-08-28 |