| |
515 Farmers Ln Santa Rosa CA 95405-4917 | |
(707) 527-8509 | |
Not Available |
Full Name | |
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Speciality | Dentist - Pediatric Dentistry |
Location | 515 Farmers Ln, Santa Rosa, California |
Authorized Official Name and Position | Cheryl Willett (TREASURER) |
Authorized Official Contact | 7075278509 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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515 Farmers Ln Santa Rosa CA 95405-4917 Ph: (707) 527-8509 | 515 Farmers Ln Santa Rosa CA 95405-4917 Ph: (707) 527-8509 |
NPI Number | 1316406309 |
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Provider Enumeration Date | 03/18/2019 |
Last Update Date | 02/20/2023 |
Identifier | Type | State | Issuer |
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1316406309 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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