Provider Demographics
NPI:1093730079
Name:SIERRA KINGS DENTAL SURGERY CENTER
Entity Type:Organization
Organization Name:SIERRA KINGS DENTAL SURGERY CENTER
Other - Org Name:SIERRA KINGS DENTAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-646-5437
Mailing Address - Street 1:145 S NEWMARK AVE
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2531
Mailing Address - Country:US
Mailing Address - Phone:559-646-5437
Mailing Address - Fax:
Practice Address - Street 1:145 SOUTH NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2531
Practice Address - Country:US
Practice Address - Phone:559-646-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid
CAPENDINGMedicare ID - Type Unspecified