| NPI | 1871963843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA D SHOTELL President 209-536-1954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 58232) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58232) |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2015-10-02 |