Healthcare Provider Details

I. General information

NPI: 1215617121
Provider Name (Legal Business Name): CATON J STATE DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 CEDAR RAVINE ROAD SUITE 203
PLACERVILLE CA
95667
US

IV. Provider business mailing address

4170 TRUXEL ROAD SUITE C
SACRAMENTO CA
95834
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-6320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: JADGEV HEIR
Title or Position: CEO/PRESIDENT
Credential:
Phone: 518-441-5483