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General NPI Number Information
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NPI Number | 1316221674
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Entity Type | Organization
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Legal Business Name | DWYER & DOW, A DENTAL CORP.
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 730 SUNRISE AVENUE #110
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City | ROSEVILLE
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State | CA
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Zip | 95661-4549
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Country | US
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Telephone | 916-784-3993
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Fax | 916-784-3916
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Provider Business Mailing Address
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Address Line | 730 SUNRISE AVENUE #110
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City | ROSEVILLE
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State | CA
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Zip | 95661-4549
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Country | US
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Telephone | 916-784-3993
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Fax | 916-784-3916
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS GEORGE DWYER
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Credential | DDS, MS
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Telephone | 916-784-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 32297
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 24221
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License Number State | CA
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