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General NPI Number Information
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NPI Number | 1245342542
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Entity Type | Organization
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Legal Business Name | RIVER OAK DENTAL SPA DENTAL OFFICE OF TOURTLOTTE DENTAL CORPORATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1473 EAST G ST STE C
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City | OAKDALE
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State | CA
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Zip | 95361
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Country | US
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Telephone | 209-848-8074
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Fax |
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Provider Business Mailing Address
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Address Line | 1473 EAST G ST STE C
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City | OAKDALE
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State | CA
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Zip | 95361
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Country | US
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Telephone | 209-848-8074
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTINA LOUISE TOURTLOTTE
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Credential | DDS
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Telephone | 209-848-8074
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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 | 40502
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License Number State | CA
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