Healthcare Provider Details

I. General information

NPI: 1003005307
Provider Name (Legal Business Name): COMMUNITY ORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WALNUT AVE
GREENFIELD CA
93927-4938
US

IV. Provider business mailing address

128 E ALISAL ST
SALINAS CA
93901-3519
US

V. Phone/Fax

Practice location:
  • Phone: 831-674-1570
  • Fax: 831-674-9058
Mailing address:
  • Phone: 831-422-6889
  • Fax: 831-422-6111

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: MRS. DEBRA ANN DIAZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-422-6889