Healthcare Provider Details

I. General information

NPI: 1144384231
Provider Name (Legal Business Name): VOLTAIRE V SAMBAJON, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 E BIDWELL ST
FOLSOM CA
95630-3556
US

IV. Provider business mailing address

2270 E BIDWELL ST
FOLSOM CA
95630-3556
US

V. Phone/Fax

Practice location:
  • Phone: 916-817-8000
  • Fax: 916-817-8004
Mailing address:
  • Phone: 916-817-8000
  • Fax: 916-817-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number40392
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA72867
License Number StateCA

VIII. Authorized Official

Name: VOLTAIRE SAMBAJON
Title or Position: PRESIDENT
Credential: DDS, MD
Phone: 916-817-8000