Elder Creek Dental
Dentist, General Practice in Sacramento, CA. Organization (NPI-2).
NPI number1154512747
StatusActive
Last updated in NPPESAug 7, 2007
Details
- NPI
- 1154512747
- Entity type
- Organization (NPI-2)
- Legal business name
- Elder Creek Dental
- Organization subpart
- No
- Enumeration date
- Aug 7, 2007
- Last updated
- Aug 7, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 18162 | CA | Yes |
Practice location
4730 47th AveSacramento, CA 95824-3946
Phone 916-391-0682
Mailing address
4730 47th AveSacramento, CA 95824-3946
Authorized official
Peter Thompson
Manager
9163910682
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