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General NPI Number Information
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NPI Number | 1679728398
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Entity Type | Organization
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Legal Business Name | ZINFANDEL DENTAL PRACTICE
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 6829 SAVINGS PL STE 101
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City | SACRAMENTO
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State | CA
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Zip | 95828-1291
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Country | US
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Telephone | 916-391-1156
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Fax |
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Provider Business Mailing Address
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Address Line | 6829 SAVINGS PL STE 101
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City | SACRAMENTO
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State | CA
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Zip | 95828-1291
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Country | US
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Telephone | 916-391-1156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD NGUYEN
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Credential | DMD
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Telephone | 916-391-1156
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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 | 50333
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License Number State | CA
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