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540 Main Street Ste. 102 Post Office Box 500 Diamond Springs CA 95619-0500 | |
| (530) 344-0290 | |
| (530) 344-0291 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 540 Main Street, Diamond Springs, California |
| Authorized Official Name and Position | Mitchell A Goodis (DENTIST) |
| Authorized Official Contact | 5303440290 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 500 Ste. 102 Diamond Springs CA 95619-0500 Ph: (530) 344-0290 | 540 Main Street Ste. 102 Post Office Box 500 Diamond Springs CA 95619-0500 Ph: (530) 344-0290 |
| NPI Number | 1235377623 |
|---|---|
| Provider Enumeration Date | 01/23/2009 |
| Last Update Date | 10/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235377623 | NPI | - | NPPES |
| 130082 | Other | CA | UMITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D43010 (California) | Primary |
T. Rutner Dds Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 493 Pleasant Valley Rd Ste. #110, Diamond Springs, CA 95619 Phone: 533-440-2900 Fax: 530-344-0290 | |
T. Rutner Dds Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 493 Main St Ste C, Diamond Springs, CA 95619 Phone: 530-344-0290 Fax: 530-344-0291 |