Healthcare Provider Details

I. General information

NPI: 1205646478
Provider Name (Legal Business Name): FOLSOM SPECIALTIES DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 FOLSOM BLVD STE B
SACRAMENTO CA
95826-2473
US

IV. Provider business mailing address

8880 CAL CENTER DR
SACRAMENTO CA
95826-3222
US

V. Phone/Fax

Practice location:
  • Phone: 916-362-9755
  • Fax:
Mailing address:
  • Phone: 818-644-0542
  • Fax:

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: DR. ARMEN JOSEPH PEZESHKIAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-644-0542