Provider Demographics
NPI:1235457755
Name:SUTTER TERRACE DENTAL GROUP
Entity type:Organization
Organization Name:SUTTER TERRACE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-736-6757
Mailing Address - Street 1:3001 P ST
Mailing Address - Street 2:SUITE #A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6523
Mailing Address - Country:US
Mailing Address - Phone:916-736-6757
Mailing Address - Fax:916-736-6755
Practice Address - Street 1:3001 P ST
Practice Address - Street 2:SUITE #A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6523
Practice Address - Country:US
Practice Address - Phone:916-736-6757
Practice Address - Fax:916-736-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty