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General NPI Number Information
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NPI Number | 1790921989
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Entity Type | Organization
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Legal Business Name | PLEASANT VALLEY DENTAL
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 6400 PLEASANT VALLEY RD
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City | EL DORADO
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State | CA
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Zip | 95623-4230
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Country | US
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Telephone | 530-622-2862
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Fax | 530-622-2072
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Provider Business Mailing Address
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Address Line | PO BOX 568
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City | EL DORADO
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State | CA
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Zip | 95623-0568
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Country | US
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Telephone | 530-622-2862
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Fax | 530-622-2072
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MITCHELL A GOODIS
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Credential | DDS
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Telephone | 530-344-0290
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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 | D43010
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License Number State | CA
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