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General NPI Number Information
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NPI Number | 1144360769
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Entity Type | Organization
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Legal Business Name | PREMIER DENTAL CARE
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 229 N MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-2306
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Country | US
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Telephone | 707-766-7373
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Fax | 707-776-7173
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Provider Business Mailing Address
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Address Line | 229 N MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-2306
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Country | US
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Telephone | 707-766-7373
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Fax | 707-776-7173
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KLAUS JOHANN RADTKE
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Credential | D.D.S.
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Telephone | 415-225-6675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 45761
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License Number State | CA
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