Full Name | |
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Speciality | Dentist - General Practice |
Location | 8125 La Plz, Cotati, California |
Authorized Official Name and Position | Ralitza Varlakova (PRESIDENT) |
Authorized Official Contact | 7079925066 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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748 Sunnyside Rd Saint Helena CA 94574-9741 Ph: () - | 8125 La Plz Cotati CA 94931-4244 Ph: (707) 992-5066 |
NPI Number | 1386143998 |
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Provider Enumeration Date | 02/09/2018 |
Last Update Date | 06/16/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386143998 | NPI | - | NPPES |
60492 | Other | CA | DENTAL BOARD LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |