| NPI | 1942728241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA DAVID ELLEFSON Dentist 707-527-0363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS100710) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2017-09-07 |