| Park Plaza Dental | |
|
245 Kentucky St Ste E Petaluma CA 94952-2877 | |
| (707) 763-4142 | |
| Not Available |
| Full Name | Park Plaza Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 245 Kentucky St Ste E, Petaluma, California |
| Authorized Official Name and Position | Mona Mahmoodi (DDS/DENTIST) |
| Authorized Official Contact | 3109935758 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Plaza Dental 245 Kentucky St Ste E Petaluma CA 94952-2877 Ph: (707) 763-4142 | Park Plaza Dental 245 Kentucky St Ste E Petaluma CA 94952-2877 Ph: (707) 763-4142 |
| NPI Number | 1154724763 |
|---|---|
| Provider Enumeration Date | 09/28/2014 |
| Last Update Date | 09/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154724763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 62200 (California) | Primary |
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