| Tchc Dental Mobile Chomp #v | |
|
1999 Mowry Avenue Fremont CA 94538-1436 | |
| (510) 770-8040 | |
| (510) 623-8926 |
| Full Name | Tchc Dental Mobile Chomp #v |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1999 Mowry Avenue, Fremont, California |
| Authorized Official Name and Position | Zettie D Page (CEO) |
| Authorized Official Contact | 5102526811 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tchc Dental Mobile Chomp #v 40910 Fremont Blvd Fremont CA 94538-4375 Ph: (510) 770-8040 | Tchc Dental Mobile Chomp #v 1999 Mowry Avenue Fremont CA 94538-1436 Ph: (510) 770-8040 |
| NPI Number | 1760606925 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 07/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760606925 | NPI | - | NPPES |
| 550000139 | Other | CA | CLINIC LICENSE |
| HAP711115F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000139 (California) | Primary |
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