Provider Demographics
NPI:1316221674
Name:DWYER & DOW, A DENTAL CORP.
Entity Type:Organization
Organization Name:DWYER & DOW, A DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:916-784-3993
Mailing Address - Street 1:730 SUNRISE AVENUE #110
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4549
Mailing Address - Country:US
Mailing Address - Phone:916-784-3993
Mailing Address - Fax:916-784-3916
Practice Address - Street 1:730 SUNRISE AVENUE #110
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4549
Practice Address - Country:US
Practice Address - Phone:916-784-3993
Practice Address - Fax:916-784-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242211223E0200X
CA322971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty