| Elder Dental Corp | |
|
19 Rotary Way Vallejo CA 94591-8475 | |
| (415) 890-1190 | |
| Not Available |
| Full Name | Elder Dental Corp |
|---|---|
| Speciality | Dentist |
| Location | 19 Rotary Way, Vallejo, California |
| Authorized Official Name and Position | Mahr Elder (OWNER) |
| Authorized Official Contact | 4158901190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elder Dental Corp 19 Rotary Way Vallejo CA 94591-8475 Ph: (415) 890-1190 | Elder Dental Corp 19 Rotary Way Vallejo CA 94591-8475 Ph: (415) 890-1190 |
| NPI Number | 1568905917 |
|---|---|
| Provider Enumeration Date | 12/01/2016 |
| Last Update Date | 12/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568905917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 93771 (California) | Primary |
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