Healthcare Provider Details

I. General information

NPI: 1376933622
Provider Name (Legal Business Name): CENTER FOR ORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 FOLSOM BLVD STE R12
SACRAMENTO CA
95827-1203
US

IV. Provider business mailing address

9521 FOLSOM BLVD STE R
SACRAMENTO CA
95827-1208
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-2699
  • Fax:
Mailing address:
  • Phone: 310-943-7752
  • Fax: 310-759-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY TURNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 310-943-7752