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General NPI Number Information
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NPI Number | 1053783779
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Entity Type | Organization
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Legal Business Name | SWEET DREAMS
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 3532 TRENTON WAY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-6958
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Country | US
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Telephone | 916-705-6346
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Fax |
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Provider Business Mailing Address
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Address Line | 3532 TRENTON WAY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-6958
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Country | US
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Telephone | 916-705-6346
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | BEVERLY DEFFEBACH
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Credential |
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Telephone | 916-705-6346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | CA
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