Provider Demographics
NPI:1124573753
Name:COURTYARD DENTAL CARE
Entity Type:Organization
Organization Name:COURTYARD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-823-2568
Mailing Address - Street 1:11990 HERITAGE OAK PL
Mailing Address - Street 2:SUITE 12
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2455
Mailing Address - Country:US
Mailing Address - Phone:530-823-2568
Mailing Address - Fax:530-823-7310
Practice Address - Street 1:11990 HERITAGE OAK PL
Practice Address - Street 2:SUITE 12
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-823-2568
Practice Address - Fax:530-823-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty