Provider Demographics
NPI:1578760096
Name:COUNTRY CLUB DENTAL CARE
Entity Type:Organization
Organization Name:COUNTRY CLUB DENTAL CARE
Other - Org Name:DAVID M. SPECTOR, D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-483-6161
Mailing Address - Street 1:2237 PARK TOWNE CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0417
Mailing Address - Country:US
Mailing Address - Phone:916-483-6161
Mailing Address - Fax:916-480-0211
Practice Address - Street 1:2237 PARK TOWNE CIR STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0417
Practice Address - Country:US
Practice Address - Phone:916-483-6161
Practice Address - Fax:916-480-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty