| NPI | 1932650249 |
|---|---|
| Doing Business As | MYTOOTHSPA DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANTHONY E DEGUZMAN Administrator 916-919-5721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 41390) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 41390) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |