| Ricuccio A. Negom Dds, A Professioal Dental Corporation | |
|
735 Tank Farm Rd Ste 170 San Luis Obispo CA 93401-7071 | |
| (805) 549-9000 | |
| (805) 549-9004 |
| Full Name | Ricuccio A. Negom Dds, A Professioal Dental Corporation |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 735 Tank Farm Rd Ste 170, San Luis Obispo, California |
| Authorized Official Name and Position | Ricuccio A Negom (OWNER, DIRECTOR, OFFICER) |
| Authorized Official Contact | 8052153349 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ricuccio A. Negom Dds, A Professioal Dental Corporation 44725 10th St W Ste 160 Lancaster CA 93534-3000 Ph: (661) 942-8555 | Ricuccio A. Negom Dds, A Professioal Dental Corporation 735 Tank Farm Rd Ste 170 San Luis Obispo CA 93401-7071 Ph: (805) 549-9000 |
| NPI Number | 1134399892 |
|---|---|
| Provider Enumeration Date | 03/09/2008 |
| Last Update Date | 03/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134399892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 55065 (California) | Primary |
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