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4217 Tierra Rejada Rd Moorpark CA 93021-3772 | |
| (805) 243-3999 | |
| (805) 243-3998 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4217 Tierra Rejada Rd, Moorpark, California |
| Authorized Official Name and Position | Zachary Potts (OWNER) |
| Authorized Official Contact | 8052433999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4217 Tierra Rejada Rd Moorpark CA 93021-3772 Ph: (805) 243-3999 | 4217 Tierra Rejada Rd Moorpark CA 93021-3772 Ph: (805) 243-3999 |
| NPI Number | 1063890937 |
|---|---|
| Provider Enumeration Date | 05/12/2015 |
| Last Update Date | 02/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063890937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 53727 (California) | Primary |
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