Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 7 Page St, Cotati, California |
Authorized Official Name and Position | Kimberly Brasil (OWNER/RDHAP) |
Authorized Official Contact | 7075482789 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
7 Page St Cotati CA 94931-4314 Ph: () - | 7 Page St Cotati CA 94931-4314 Ph: (707) 665-6122 |
NPI Number | 1396477485 |
---|---|
Provider Enumeration Date | 06/27/2022 |
Last Update Date | 06/29/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396477485 | NPI | - | NPPES |
1780800383 | Other | CA | DDS |
1083112221 | Other | CA | RDHAP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |