MEDICARE: ARENA GADE WILKES MILLA MCCLURE DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1447288006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARENA GADE WILKES MILLA MCCLURE DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	5410 PARK DR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5562
Country	:	US
Telephone Number	:	916-435-2475
Fax Number	:	916-435-2450

Provider Business Practice Location Address
First Line	:	5410 PARK DR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5562
Country	:	US
Telephone Number	:	916-435-2475
Fax Number	:	916-435-2450

Authorized Official
Title or Position	:	PC HOLDER
Name	:	MARK MARK ARENA
Credential	:	DDS
Telephone Number	:	916-435-2475

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/30/2016

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