Provider Demographics
NPI:1235274754
Name:SERAFICA, REGINA PRONSTROLLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:PRONSTROLLER
Last Name:SERAFICA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 BROOKS RD S
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7811
Mailing Address - Country:US
Mailing Address - Phone:707-836-8685
Mailing Address - Fax:707-836-8631
Practice Address - Street 1:9046 BROOKS RD S
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7811
Practice Address - Country:US
Practice Address - Phone:707-836-8685
Practice Address - Fax:707-836-8631
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-93771-01Medicaid
CAB-48180-01OtherHEALTHY FAMILIES