| Wellspring Dental Group | |
|
1700 Pennsylvania Ave Suite D Fairfield CA 94533-3588 | |
| (925) 336-9611 | |
| Not Available |
| Full Name | Wellspring Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1700 Pennsylvania Ave, Fairfield, California |
| Authorized Official Name and Position | Hyo S Kang (PRESIDENT) |
| Authorized Official Contact | 9253369611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Dental Group 8051 Briar Oaks Dr San Ramon CA 94582-5196 Ph: (925) 336-9611 | Wellspring Dental Group 1700 Pennsylvania Ave Suite D Fairfield CA 94533-3588 Ph: (925) 336-9611 |
| NPI Number | 1548618580 |
|---|---|
| Provider Enumeration Date | 06/01/2016 |
| Last Update Date | 06/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548618580 | NPI | - | NPPES |
| 1972793651 | Other | CA | NATIONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 56041 (California) | Primary |
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