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General NPI Number Information
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NPI Number | 1629648803
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Entity Type | Organization
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Legal Business Name | SIMONNE PEREIRA PATRIC DDS , CORPORATION
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 3535 ELVERTA RD STE E
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City | ANTELOPE
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State | CA
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Zip | 95843-4721
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Country | US
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Telephone | 916-692-8633
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Fax | 916-692-8638
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Provider Business Mailing Address
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Address Line | 3535 ELVERTA RD STE E
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City | ANTELOPE
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State | CA
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Zip | 95843-4721
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Country | US
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Telephone | 916-692-8633
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Fax | 916-692-8638
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIMONNE PEREIRA PATRICK
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Credential | DDS
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Telephone | 916-600-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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