Healthcare Provider Details

I. General information

NPI: 1891192597
Provider Name (Legal Business Name): COUCH AND HAMMOND DENTISTRY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 CAMERADO DR SUITE 100
CAMERON PARK CA
95682-7636
US

IV. Provider business mailing address

970 CAMERADO DR SUITE 100
CAMERON PARK CA
95682-7636
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-0723
  • Fax: 530-677-0723
Mailing address:
  • Phone: 530-677-0723
  • Fax: 530-677-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM BART COUCH
Title or Position: DENTIST
Credential: DMD
Phone: 530-677-0723