Provider Demographics
NPI:1467635250
Name:PLACER DERMATOLOGY & SKIN CARE CENTER INC.
Entity Type:Organization
Organization Name:PLACER DERMATOLOGY & SKIN CARE CENTER INC.
Other - Org Name:PLACER DERMATOLOGY & SKIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-797-6261
Mailing Address - Street 1:9624 WEXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-7113
Mailing Address - Country:US
Mailing Address - Phone:916-797-6261
Mailing Address - Fax:
Practice Address - Street 1:9285 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-784-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72699207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty