| Mytoothspa Dentistry And Orthodontics | |
|
2436 Professional Dr Suite 200 Roseville CA 95661-7779 | |
| (916) 774-9920 | |
| (916) 910-0752 |
| Full Name | Mytoothspa Dentistry And Orthodontics |
|---|---|
| Speciality | Dentist |
| Location | 2436 Professional Dr, Roseville, California |
| Authorized Official Name and Position | Anthony Escano Deguzman (ADMINISTARTOR) |
| Authorized Official Contact | 9169195721 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mytoothspa Dentistry And Orthodontics 5060 Sunrise Blvd Suite A3 Fair Oaks CA 95628-4944 Ph: (916) 919-5721 | Mytoothspa Dentistry And Orthodontics 2436 Professional Dr Suite 200 Roseville CA 95661-7779 Ph: (916) 774-9920 |
| NPI Number | 1487031027 |
|---|---|
| Provider Enumeration Date | 05/04/2015 |
| Last Update Date | 05/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487031027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 41390 (California) | Primary |
| 305R00000X | Preferred Provider Organization | 41390 (California) | Secondary |
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