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General NPI Number Information
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NPI Number | 1811335755
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Entity Type | Organization
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Legal Business Name | RINCON FAMILY DENTAL
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 55 ELAINE DR
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City | SANTA ROSA
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State | CA
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Zip | 95409-4248
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Country | US
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Telephone | 707-523-7423
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Fax |
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Provider Business Mailing Address
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Address Line | 55 ELAINE DR
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City | SANTA ROSA
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State | CA
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Zip | 95409-4248
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Country | US
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Telephone | 707-523-7423
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. GERRET W OSENDORF
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Credential | DDS
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Telephone | 707-523-7423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56052
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License Number State |
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