Healthcare Provider Details

I. General information

NPI: 1750609806
Provider Name (Legal Business Name): CAMELIA O CIFOR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 COYLE AVE SUITE 7
CARMICHAEL CA
95608-0301
US

IV. Provider business mailing address

6342 WEXFORD CIR
CITRUS HEIGHTS CA
95621-4940
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-7682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: