Provider Demographics
NPI:1598963878
Name:ELIZABETH CAOILI DENTAL CORPORATION
Entity Type:Organization
Organization Name:ELIZABETH CAOILI DENTAL CORPORATION
Other - Org Name:CAOILI DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LLOREN
Authorized Official - Last Name:CAOILI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-643-5709
Mailing Address - Street 1:4380 SONOMA BLVD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2266
Mailing Address - Country:US
Mailing Address - Phone:707-643-5709
Mailing Address - Fax:707-649-9342
Practice Address - Street 1:4380 SONOMA BLVD
Practice Address - Street 2:SUITE 177
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2266
Practice Address - Country:US
Practice Address - Phone:707-643-5709
Practice Address - Fax:707-649-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty