Healthcare Provider Details

I. General information

NPI: 1821810201
Provider Name (Legal Business Name): PAOLO A POIDMORE AND BRIAN C CRAWFORD DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11961 HERITAGE OAK PL
AUBURN CA
95603-2461
US

IV. Provider business mailing address

3075 BEACON BLVD
WEST SACRAMENTO CA
95691-3462
US

V. Phone/Fax

Practice location:
  • Phone: 916-259-9255
  • Fax: 916-384-3844
Mailing address:
  • Phone: 916-259-9255
  • Fax: 916-384-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PAOLO POIDMORE
Title or Position: OWNER
Credential:
Phone: 916-259-9255