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General NPI Number Information
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NPI Number | 1245308378
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Entity Type | Organization
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Legal Business Name | SACRAMENTO DERMATOLOGY MED GROUP INC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 5525 DEWEY DR #102
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City | FAIR OAKS
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State | CA
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Zip | 95628-3129
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Country | US
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Telephone | 916-966-9014
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Fax | 916-966-9015
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Provider Business Mailing Address
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Address Line | 5525 DEWEY DR #102
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City | FAIR OAKS
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State | CA
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Zip | 95628-3129
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Country | US
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Telephone | 916-966-9014
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Fax | 916-966-9015
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS DAUGHTERS
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Credential | MD
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Telephone | 916-966-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G22335
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A24330
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License Number State | CA
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