Provider Demographics
NPI:1578793691
Name:MICHAEL S. FIFE DDS INC.
Entity Type:Organization
Organization Name:MICHAEL S. FIFE DDS INC.
Other - Org Name:CRAFTSMAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-974-1160
Mailing Address - Street 1:1801 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2106
Mailing Address - Country:US
Mailing Address - Phone:916-974-1160
Mailing Address - Fax:916-974-1163
Practice Address - Street 1:1801 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2106
Practice Address - Country:US
Practice Address - Phone:916-974-1160
Practice Address - Fax:916-974-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39545OtherSTATE LICENSE
CA39545OtherSTATE LICENSE