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MANGRUM DENTAL CORPORATION NPI 1275776684


NPI Information

NPI: 1275776684
Provider Name: MANGRUM DENTAL CORPORATION

Doing Business As: PETALUMA DENTAL GROUP

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
1430 E WASHINGTON ST
PETALUMA, CA
ZIP 94954
Phone: (707) 762-0067
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MANGRUM DENTAL CORPORATION is a general practice dentist in Petaluma, CA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MANGRUM DENTAL CORPORATION NPI is 1275776684. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Petaluma Dental Group.

The provider's business location address is:

1430 E WASHINGTON ST
PETALUMA, CA
ZIP 94954-631
Phone: (707) 762-0067
Fax: (707) 762-4782

The provider's authorized official is Debra A Quackenbush .
The authorized official title is Office Manager and has the following contact phone number (707) 762-0067.

The enumeration date for this NPI number is 4/15/2009 and was last updated on 4/15/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice44612CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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