| NPI | 1871896753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STAGIS Dentist 559-439-1245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 28987) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59735) |
| 1223G0001X Dentist, General Practice (Licence: CA 54793) | |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |