Provider Demographics
NPI:1275942880
Name:SEQUOIA VALLEY DENTAL GROUP
Entity Type:Organization
Organization Name:SEQUOIA VALLEY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARLON
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-784-1922
Mailing Address - Street 1:821 W MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257
Mailing Address - Country:US
Mailing Address - Phone:559-784-1922
Mailing Address - Fax:559-784-1149
Practice Address - Street 1:821 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3131
Practice Address - Country:US
Practice Address - Phone:559-784-1922
Practice Address - Fax:559-784-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty