| Portia Maristela Escobar, Professional Dental Corporation | |
|
3772 Sonoma Blvd Vallejo CA 94589-2202 | |
| (707) 557-6680 | |
| (707) 554-6688 |
| Full Name | Portia Maristela Escobar, Professional Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3772 Sonoma Blvd, Vallejo, California |
| Authorized Official Name and Position | Portia Escobar (PRESIDENT) |
| Authorized Official Contact | 7075576680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portia Maristela Escobar, Professional Dental Corporation 3772 Sonoma Blvd Vallejo CA 94589-2202 Ph: (707) 557-6680 | Portia Maristela Escobar, Professional Dental Corporation 3772 Sonoma Blvd Vallejo CA 94589-2202 Ph: (707) 557-6680 |
| NPI Number | 1699890350 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 04/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699890350 | NPI | - | NPPES |
| B45854-01 | Other | CA | HEALTHY FAMILIES |
| B45854-01 | Other | CA | DENTI-CAL, MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 45854 (California) | Primary |
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