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1060 Ski Run Blvd South Lake Tahoe CA 96150-7478 | |
| (530) 541-7040 | |
| (530) 541-3429 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1060 Ski Run Blvd, South Lake Tahoe, California |
| Authorized Official Name and Position | Mireya Ortega (PRESIDENT) |
| Authorized Official Contact | 5305417040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1060 Ski Run Blvd South Lake Tahoe CA 96150-7478 Ph: (530) 541-7040 | 1060 Ski Run Blvd South Lake Tahoe CA 96150-7478 Ph: (530) 541-7040 |
| NPI Number | 1295971521 |
|---|---|
| Provider Enumeration Date | 12/16/2008 |
| Last Update Date | 12/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295971521 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 35530 (California) | Primary |
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