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999 E Stanley Blvd Ste C Livermore CA 94550-4050 | |
| (925) 371-0300 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 999 E Stanley Blvd Ste C, Livermore, California |
| Authorized Official Name and Position | Vicenta Reyes (LEAD OF CREDENTIALING) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
999 E Stanley Blvd Ste C Livermore CA 94550-4050 Ph: (925) 371-0300 | 999 E Stanley Blvd Ste C Livermore CA 94550-4050 Ph: (925) 371-0300 |
| NPI Number | 1417694845 |
|---|---|
| Provider Enumeration Date | 05/17/2022 |
| Last Update Date | 05/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417694845 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Primary |
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Secondary |
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