|
| |
|
1110 N Dutton Ave Santa Rosa CA 95401-4606 | |
| (707) 303-3600 | |
| (707) 396-5155 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1110 N Dutton Ave, Santa Rosa, California |
| Authorized Official Name and Position | Gabriela Bernal-leroi (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7073033600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3569 Round Barn Cir Santa Rosa CA 95403-5781 Ph: (707) 303-3600 | 1110 N Dutton Ave Santa Rosa CA 95401-4606 Ph: (707) 303-3600 |
| NPI Number | 1023439759 |
|---|---|
| Provider Enumeration Date | 12/24/2013 |
| Last Update Date | 12/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023439759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Western Dental Services, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1144 Sonoma Ave Ste 108, Santa Rosa, CA 95405 Phone: 707-523-2399 Fax: 707-523-1411 | |
Stephanie Settimi Dds, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2798 Yulupa Ave Ste 3, Santa Rosa, CA 95405 Phone: 707-542-7299 |