| NPI | 1881915106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA LILIBETH LICAYAN JOSE President 510-690-9896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 40449) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2013-09-23 |