| NPI | 1972908051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED G DANIELSON President 916-230-8837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 52846) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2014-10-31 |