| NPI | 1922455575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE VAN Dentist 408-298-8187 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 40506) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-05-24 |