| Summit Dental Practice | |
|
25004 Blue Ravine Rd Folsom CA 95630-5283 | |
| (916) 355-8400 | |
| (916) 355-8460 |
| Full Name | Summit Dental Practice |
|---|---|
| Speciality | Dentist |
| Location | 25004 Blue Ravine Rd, Folsom, California |
| Authorized Official Name and Position | Mahnaz Moussavi (DDS) |
| Authorized Official Contact | 9163558400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Dental Practice 25004 Blue Ravine Rd Folsom CA 95630-5283 Ph: (916) 355-8400 | Summit Dental Practice 25004 Blue Ravine Rd Folsom CA 95630-5283 Ph: (916) 355-8400 |
| NPI Number | 1578956363 |
|---|---|
| Provider Enumeration Date | 03/18/2015 |
| Last Update Date | 03/18/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578956363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 39990 (California) | Primary |
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