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General NPI Number Information
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NPI Number | 1497540298
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Entity Type | Organization
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Legal Business Name | PORTIA OBLEA DENTAL CORPORATION
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 501 NUT TREE CT STE B
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City | VACAVILLE
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State | CA
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Zip | 95687-4637
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Country | US
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Telephone | 707-532-2197
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Fax |
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Provider Business Mailing Address
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Address Line | 501 NUT TREE CT STE B
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City | VACAVILLE
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State | CA
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Zip | 95687-4637
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Country | US
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Telephone | 707-532-2197
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ARUN RAMAKUMAR
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Credential |
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Telephone | 408-656-4567
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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