| Dental Source Of California | |
|
2200 Professional Dr Suite 210 Roseville CA 95661-7763 | |
| (916) 786-6157 | |
| (916) 786-0783 |
| Full Name | Dental Source Of California |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2200 Professional Dr, Roseville, California |
| Authorized Official Name and Position | Donald Clarke (CORPOATION PRESIDENT) |
| Authorized Official Contact | 9164870117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Source Of California 2200 Professional Dr Suite 210 Roseville CA 95661-7763 Ph: (916) 786-6157 | Dental Source Of California 2200 Professional Dr Suite 210 Roseville CA 95661-7763 Ph: (916) 786-6157 |
| NPI Number | 1972610046 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 01/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972610046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 33738 (California) | Primary |
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