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General NPI Number Information
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NPI Number | 1558672956
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Entity Type | Organization
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Legal Business Name | JACK L. SEMMENS DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 495 NO LAKE BLVD,
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City | TAHOE CITY
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State | CA
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Zip | 96145
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Country | US
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Telephone | 530-583-5546
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1912
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City | TAHOE CITY
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State | CA
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Zip | 96145-1912
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Country | US
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Telephone | 530-583-5546
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Fax | 539-583-3559
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK L. SEMMENS
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Credential | DENTIST
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Telephone | 530-583-5546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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