| St. Joseph Health Mobile Dental | |
|
751 Lombardi Ct Santa Rosa CA 95407 | |
| (707) 547-2237 | |
| (707) 547-2230 |
| Full Name | St. Joseph Health Mobile Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 751 Lombardi Ct, Santa Rosa, California |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY FOR ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Joseph Health Mobile Dental 751 Lombardi Ct Santa Rosa CA 95407-6793 Ph: (707) 547-2237 | St. Joseph Health Mobile Dental 751 Lombardi Ct Santa Rosa CA 95407 Ph: (707) 547-2237 |
| NPI Number | 1326174319 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 11/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326174319 | NPI | - | NPPES |
| G9048301 | Other | CA | MEDICAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 110000498 (California) | Primary |
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