| NPI | 1871174730 |
|---|---|
| Doing Business As | ROSEVILLE WISDOM TEETH |
| Entity Type | Organization |
| Authorized Contact | JEREMY MARTIN STARR CEO 916-769-8486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |