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General NPI Number Information
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NPI Number | 1255061354
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Entity Type | Organization
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Legal Business Name | NOVA TELEDENTISTRY
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 8111 AZTEC WAY
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City | ANTELOPE
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State | CA
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Zip | 95843-4411
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Country | US
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Telephone | 916-540-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 7451 AUBURN BLVD STE C
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-2992
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ROXANNE ROCCANOVA
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Credential |
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Telephone | 916-540-0737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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