Provider Demographics
NPI:1154302123
Name:CONTRA COSTA COMMUNITY COLLEGE DISTRICT
Entity Type:Organization
Organization Name:CONTRA COSTA COMMUNITY COLLEGE DISTRICT
Other - Org Name:DIABLO VALLEY COLLEGE DENTAL HYGIENE DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-685-1230
Mailing Address - Street 1:321 GOLF CLUB RD
Mailing Address - Street 2:LHS 102
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1529
Mailing Address - Country:US
Mailing Address - Phone:925-685-1230
Mailing Address - Fax:925-689-6529
Practice Address - Street 1:321 GOLF CLUB RD
Practice Address - Street 2:LHS 102
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1529
Practice Address - Country:US
Practice Address - Phone:925-685-1230
Practice Address - Fax:925-689-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9080301OtherMEDI-CAL