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NPI Code Detail

MEDICARE: PACIFIC DENTAL SERVICES

MEDICARE: PACIFIC DENTAL SERVICES
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
1122300000XDentist64819CA

General Provider Information

NPI Number : 1992181911
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFIC DENTAL SERVICES
Provider Business Mailing Address
First Line : 6660 LONE TREE WAY STE 7
Second Line :
City : BRENTWOOD
State : CA
Zip : 94513-5310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6660 LONE TREE WAY STE 7
Second Line :
City : BRENTWOOD
State : CA
Zip : 94513-5310
Country : US
Telephone Number : 925-513-8363
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : MATT PAUL
Credential :
Telephone Number : 925-513-8363
Provider Enumeration Date : 07/31/2015
Last Update Date : 07/31/2015

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Directions to “PACIFIC DENTAL SERVICES ” Practice Location

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