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3536 Mendocino Ave Suite 330 Santa Rosa CA 95403-3634 | |
| (707) 545-4104 | |
| (707) 545-9668 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3536 Mendocino Ave, Santa Rosa, California |
| Authorized Official Name and Position | Emine C Loxley (OWNER) |
| Authorized Official Contact | 7075454104 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3536 Mendocino Ave Suite 330 Santa Rosa CA 95403-3634 Ph: (707) 545-4104 | 3536 Mendocino Ave Suite 330 Santa Rosa CA 95403-3634 Ph: (707) 545-4104 |
| NPI Number | 1134517139 |
|---|---|
| Provider Enumeration Date | 12/30/2014 |
| Last Update Date | 12/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134517139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 57813 (California) | Primary |
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