Provider Demographics
NPI:1629405469
Name:MICHAEL FRENCH DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL FRENCH DDS DENTAL CORPORATION
Other - Org Name:SAFARI SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-588-8400
Mailing Address - Street 1:800 MORNING STAR DR STE B
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9260
Mailing Address - Country:US
Mailing Address - Phone:209-588-8400
Mailing Address - Fax:209-588-8811
Practice Address - Street 1:800 MORNING STAR DR STE B
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9260
Practice Address - Country:US
Practice Address - Phone:209-588-8400
Practice Address - Fax:209-588-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861521692OtherMEDI-CAL