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General NPI Number Information
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NPI Number | 1679076822
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Entity Type | Organization
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Legal Business Name | TADESSE TESFAMICHAEL, DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 6580 HEMBREE LN STE 255
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City | WINDSOR
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State | CA
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Zip | 95492-6885
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Country | US
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Telephone | 707-836-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 6580 HEMBREE LN STE 255
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City | WINDSOR
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State | CA
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Zip | 95492-6885
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Country | US
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Telephone | 707-836-1202
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | TAD TESFAMICHAEL
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Credential | DDS
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Telephone | 707-836-1202
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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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