| NPI | 1912347212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY LYONS President 916-442-7873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2016-02-08 |