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General NPI Number Information
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NPI Number | 1962952762
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Entity Type | Organization
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Legal Business Name | SANTA CRUZ DENTAL GROUP
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 1017 MISSION ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3524
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Country | US
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Telephone | 831-426-3535
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Fax | 831-454-0330
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Provider Business Mailing Address
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Address Line | 1017 MISSION ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3524
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Country | US
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Telephone | 831-426-3535
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Fax | 831-454-0330
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MAX WILSON
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Credential |
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Telephone | 831-426-3535
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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 | 50398
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50395
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 32389
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License Number State | CA
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