Healthcare Provider Details

I. General information

NPI: 1831676675
Provider Name (Legal Business Name): FONDA WEBBER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8329 FAIR OAKS BLVD STE D
CARMICHAEL CA
95608-1949
US

IV. Provider business mailing address

1457 MARIETTA CT
FOLSOM CA
95630-6640
US

V. Phone/Fax

Practice location:
  • Phone: 916-769-3189
  • Fax:
Mailing address:
  • Phone: 916-769-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAMON WEBBER
Title or Position: SECRETARY
Credential:
Phone: 916-571-2781