| NPI | 1962735993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE BLAKE Insurance Specialist 916-691-1050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 22639744) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2009-09-09 |