Provider Demographics
NPI:1225437353
Name:ACCESS PROFESSIONAL DENTAL CARE,LLC
Entity Type:Organization
Organization Name:ACCESS PROFESSIONAL DENTAL CARE,LLC
Other - Org Name:BLUE HILLS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-563-6002
Mailing Address - Street 1:8890 CAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3200
Mailing Address - Country:US
Mailing Address - Phone:916-922-5000
Mailing Address - Fax:916-646-9000
Practice Address - Street 1:6540 S STATE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7219
Practice Address - Country:US
Practice Address - Phone:801-590-8466
Practice Address - Fax:801-905-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty