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General NPI Number Information
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NPI Number | 1972625648
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Entity Type | Organization
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Legal Business Name | SERENITY DENTAL OFFICE
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4130 TRUXEL RD #E
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City | SACRAMENTO
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State | CA
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Zip | 95834-3760
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Country | US
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Telephone | 916-285-9400
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Fax | 916-285-8636
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Provider Business Mailing Address
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Address Line | 4130 TRUXEL RD #E
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City | SACRAMENTO
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State | CA
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Zip | 95834-3760
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Country | US
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Telephone | 916-285-9400
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Fax | 916-285-8636
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER VILDERMAN
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Credential | DDS
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Telephone | 916-285-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40753
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License Number State | CA
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