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General NPI Number Information
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NPI Number | 1821480153
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Entity Type | Organization
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Legal Business Name | SACRAMENTO DENTISTRY GROUP
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 1105 E ST
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City | SACRAMENTO
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State | CA
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Zip | 95814-0818
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Country | US
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Telephone | 916-538-6900
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Fax | 916-538-6875
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Provider Business Mailing Address
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Address Line | 1105 E ST
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City | SACRAMENTO
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State | CA
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Zip | 95814-0818
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Country | US
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Telephone | 916-538-6900
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Fax | 916-538-6875
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIANA ROMO
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Credential |
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Telephone | 916-538-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 57798
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License Number State | CA
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