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General NPI Number Information
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NPI Number | 1659893824
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Entity Type | Organization
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Legal Business Name | DR AMY WOO A PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2627 K ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-5103
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Country | US
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Telephone | 916-443-8955
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 K ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-5103
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Country | US
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Telephone | 916-443-8955
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MRS. BRENDA ANN WARUCH
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Credential |
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Telephone | 916-443-8955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37757
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License Number State | CA
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