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General NPI Number Information
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NPI Number | 1568455053
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Entity Type | Organization
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Legal Business Name | GREENVILLE RANCHERIA
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 343 OAK STREET
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City | RED BLUFF
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State | CA
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Zip | 96080-4605
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Country | US
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Telephone | 530-528-8600
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Fax | 530-528-8612
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Provider Business Mailing Address
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Address Line | P O BOX 279
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City | GREENVILLE
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State | CA
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Zip | 95947-0279
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Country | US
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Telephone | 530-284-7990
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Fax | 530-284-7299
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARGARET A ALSPAUGH
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Credential | M.D., PLD
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Telephone | 530-528-8600
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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 | 32161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56174
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License Number State | CA
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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 | 59948
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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