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General NPI Number Information
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NPI Number | 1730530668
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Entity Type | Organization
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Legal Business Name | RATCHFORD DENTAL PRACTICE OF LOS OSOS, INC.
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 2238 BAYVIEW HEIGHTS DR STE. N
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City | LOS OSOS
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State | CA
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Zip | 93402-3921
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Country | US
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Telephone | 931-802-4893
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Fax |
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Provider Business Mailing Address
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Address Line | 747 BERNARDO AVE
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City | MORRO BAY
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State | CA
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Zip | 93442-2339
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Country | US
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Telephone | 805-772-8585
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MR. FOREST RATCHFORD
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Credential |
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Telephone | 931-802-4893
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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 | 61353
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License Number State | CA
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