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General NPI Number Information
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NPI Number | 1811154313
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Entity Type | Organization
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Legal Business Name | SCRIPPS DENTAL GROUP
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 79 SCRIPPS DR STE 204
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City | SACRAMENTO
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State | CA
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Zip | 95825-6208
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Country | US
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Telephone | 916-565-2570
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Fax | 916-565-2575
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Provider Business Mailing Address
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Address Line | 79 SCRIPPS DR STE 204
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City | SACRAMENTO
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State | CA
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Zip | 95825-6208
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Country | US
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Telephone | 916-565-2570
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Fax | 916-565-2575
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER HERBERT
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Credential |
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Telephone | 916-565-2570
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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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