Provider Demographics
NPI:1083373096
Name:SCRIPPS FAMILY DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:SCRIPPS FAMILY DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOULADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-889-4784
Mailing Address - Street 1:103 SCRIPPS DR STE 8
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6316
Mailing Address - Country:US
Mailing Address - Phone:916-929-1156
Mailing Address - Fax:
Practice Address - Street 1:103 SCRIPPS DR STE 8
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6316
Practice Address - Country:US
Practice Address - Phone:916-929-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty