| Dental Source Of California | |
|
25005 Blue Ravine Rd Ste 100 Folsom CA 95630-5706 | |
| (916) 600-3719 | |
| Not Available |
| Full Name | Dental Source Of California |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 25005 Blue Ravine Rd Ste 100, Folsom, California |
| Authorized Official Name and Position | Donald Clarke (PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 9164870117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Source Of California 3901 Marconi Ave Sacramento CA 95821-3902 Ph: (916) 487-0117 | Dental Source Of California 25005 Blue Ravine Rd Ste 100 Folsom CA 95630-5706 Ph: (916) 600-3719 |
| NPI Number | 1083362537 |
|---|---|
| Provider Enumeration Date | 03/14/2022 |
| Last Update Date | 05/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083362537 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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