Healthcare Provider Details

I. General information

NPI: 1043382724
Provider Name (Legal Business Name): COMMUNITY DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PLAZA DR SUITE R
VALLEJO CA
94591-3703
US

IV. Provider business mailing address

2 MACARTHUR PL SUITE 700
SANTA ANA CA
92707-5924
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-6245
  • Fax: 707-557-0986
Mailing address:
  • Phone: 714-708-5308
  • Fax: 714-708-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINE SALCIDO
Title or Position: CONTRACT SUPERVISOR
Credential:
Phone: 714-708-5308