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1801 Professional Dr Sacramento CA 95825-2106 | |
| (916) 974-1160 | |
| (916) 974-1163 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1801 Professional Dr, Sacramento, California |
| Authorized Official Name and Position | Michael Stewart Fife (PRESIDENT) |
| Authorized Official Contact | 9169741160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1801 Professional Dr Sacramento CA 95825-2106 Ph: (916) 974-1160 | 1801 Professional Dr Sacramento CA 95825-2106 Ph: (916) 974-1160 |
| NPI Number | 1316001530 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316001530 | NPI | - | NPPES |
| 40350 | Other | CA | CA DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 40350 (California) | Primary |
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