| Disick Dental Corporation | |
|
591 Redwood Hwy Building 2000, Suite 2110 Mill Valley CA 94941-6001 | |
| (415) 381-4321 | |
| (415) 381-4056 |
| Full Name | Disick Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 591 Redwood Hwy, Mill Valley, California |
| Authorized Official Name and Position | Evan Schaffer Disick (PRESIDENT) |
| Authorized Official Contact | 4153814321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Disick Dental Corporation 591 Redwood Hwy Building 2000, Suite 2110 Mill Valley CA 94941-6001 Ph: (415) 381-4321 | Disick Dental Corporation 591 Redwood Hwy Building 2000, Suite 2110 Mill Valley CA 94941-6001 Ph: (415) 381-4321 |
| NPI Number | 1821019407 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821019407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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