Healthcare Provider Details

I. General information

NPI: 1386716082
Provider Name (Legal Business Name): COMMUNITY DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36416 FREMONT BLVD
FREMONT CA
94536-7436
US

IV. Provider business mailing address

2 MACARTHUR PL SUITE 700
SANTA ANA CA
92707-5924
US

V. Phone/Fax

Practice location:
  • Phone: 510-739-3889
  • Fax: 510-739-2373
Mailing address:
  • Phone: 714-708-5308
  • Fax: 714-708-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINE SALCIDO
Title or Position: CONTRACT SUPERVISOR
Credential:
Phone: 714-708-5308