Provider Demographics
NPI:1033234877
Name:MU MU MIN DMD MSD INC
Entity Type:Organization
Organization Name:MU MU MIN DMD MSD INC
Other - Org Name:VACAVILLE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MU MU
Authorized Official - Middle Name:
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:707-449-8808
Mailing Address - Street 1:2611 NUT TREE RD
Mailing Address - Street 2:SUITE #D
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6839
Mailing Address - Country:US
Mailing Address - Phone:707-449-8808
Mailing Address - Fax:707-449-6303
Practice Address - Street 1:2611 NUT TREE RD
Practice Address - Street 2:SUITE #D
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6839
Practice Address - Country:US
Practice Address - Phone:707-449-8808
Practice Address - Fax:707-449-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty