Healthcare Provider Details

I. General information

NPI: 1467954545
Provider Name (Legal Business Name): M. ARLENITA O. GOMEZ-CRODDY, DDS, A PROFESSIONAL DENTAL CORPROATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MADISON AVE STE 12
CARMICHAEL CA
95608-0645
US

IV. Provider business mailing address

6600 MADISON AVE STE 12
CARMICHAEL CA
95608-0645
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-4522
  • Fax: 916-961-0406
Mailing address:
  • Phone: 916-961-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number38533
License Number StateCA

VIII. Authorized Official

Name: DR. M. ARLENITA OQUENDO GOMEZ-CRODDY
Title or Position: PRESIDENT
Credential: DDS
Phone: 916-961-4522