Healthcare Provider Details

I. General information

NPI: 1447972096
Provider Name (Legal Business Name): MONTEREY PENINSULA GENERAL DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EL DORADO ST
MONTEREY CA
93940-4645
US

IV. Provider business mailing address

333 EL DORADO ST
MONTEREY CA
93940-4645
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-3068
  • Fax: 831-655-6434
Mailing address:
  • Phone: 831-655-6448
  • Fax: 831-655-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NICOLE VENTURA THOMPSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 831-655-6448