Healthcare Provider Details

I. General information

NPI: 1932263415
Provider Name (Legal Business Name): JON-ERIC HOTTINGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 ELK GROVE BLVD #300
ELK GROVE CA
95758-5964
US

IV. Provider business mailing address

1624 41ST ST
SACRAMENTO CA
95819-4045
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-8020
  • Fax: 916-683-8025
Mailing address:
  • Phone: 916-396-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number245704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: