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General NPI Number Information
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NPI Number | 1003908096
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Entity Type | Individual
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Provider Name | SCOTT PERRINE CHURCHILL DMD
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 2001 ZINFANDEL DR SUITE A2
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-4265
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Country | US
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Telephone | 916-638-4641
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Fax | 916-638-4795
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Provider Business Mailing Address
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Address Line | PO BOX 1706
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City | FAIR OAKS
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State | CA
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Zip | 95628-1706
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Country | US
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Telephone | 916-638-4641
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Fax | 916-638-4795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25873
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License Number State | CA
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