Provider Demographics
NPI:1497280267
Name:REDWOOD FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:REDWOOD FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA MARIE
Authorized Official - Middle Name:ZALDIVAR
Authorized Official - Last Name:LARGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-552-8668
Mailing Address - Street 1:1782 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2619
Mailing Address - Country:US
Mailing Address - Phone:707-552-8668
Mailing Address - Fax:707-552-8052
Practice Address - Street 1:1782 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2619
Practice Address - Country:US
Practice Address - Phone:707-552-8668
Practice Address - Fax:707-552-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50299261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental