| |
3000 L St Suite 104 Sacramento CA 95816-5248 | |
(916) 737-6453 | |
(916) 737-3075 |
Full Name | |
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Speciality | Dentist |
Location | 3000 L St, Sacramento, California |
Authorized Official Name and Position | Chris Campbell (OFFICE MANAGER) |
Authorized Official Contact | 9167376453 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3000 L St Suite 104 Sacramento CA 95816-5248 Ph: (916) 737-6453 | 3000 L St Suite 104 Sacramento CA 95816-5248 Ph: (916) 737-6453 |
NPI Number | 1184822462 |
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Provider Enumeration Date | 07/06/2007 |
Last Update Date | 12/07/2010 |
Medicare PECOS PAC ID | 6901946144 |
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Medicare Enrollment ID | O20100930023637 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184822462 | NPI | - | NPPES |
45975 | Other | CA | STATE DENTAL LICENSE # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 45975 (California) | Primary |
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