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General NPI Number Information
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NPI Number | 1568549541
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Entity Type | Organization
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Legal Business Name | COLUMBIA-ARORA
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 599 TOMALES RD
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City | PETALUMA
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State | CA
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Zip | 94952-5002
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Country | US
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Telephone | 707-765-7234
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Fax |
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Provider Business Mailing Address
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Address Line | 6490 FRONT ST #207
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City | FORESTVILLE
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State | CA
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Zip | 95436-9604
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Country | US
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Telephone | 707-765-7234
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Fax |
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Authorized Official
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Title or Position | RDA DENTAL ASST
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Name | MR. ROBERT FLOYD WILSON JR.
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Credential | RDA
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Telephone | 707-765-7234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | RDA47476
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License Number State | CA
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