| NPI | 1861647422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL MARIE PETERSEN Secretary/Office Manager 805-569-1795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 39964) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2013-06-19 |