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1171 Murrieta Blvd Suite 200 Livermore CA 94550-4143 | |
| (925) 449-6633 | |
| (925) 449-0766 |
| Full Name | |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1171 Murrieta Blvd, Livermore, California |
| Authorized Official Name and Position | Shayna Rondon (PRESIDENT) |
| Authorized Official Contact | 9254496633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1171 Murrieta Blvd Suite 200 Livermore CA 94550-4143 Ph: (925) 449-6633 | 1171 Murrieta Blvd Suite 200 Livermore CA 94550-4143 Ph: (925) 449-6633 |
| NPI Number | 1942608773 |
|---|---|
| Provider Enumeration Date | 12/10/2014 |
| Last Update Date | 12/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942608773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 59292 (California) | Primary |
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