Provider Demographics
NPI:1639499825
Name:SIERRA OAKS DENTAL GROUP
Entity Type:Organization
Organization Name:SIERRA OAKS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-481-2000
Mailing Address - Street 1:3406 AMERICAN RIVER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5746
Mailing Address - Country:US
Mailing Address - Phone:916-481-2000
Mailing Address - Fax:916-481-2358
Practice Address - Street 1:3406 AMERICAN RIVER DR
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5746
Practice Address - Country:US
Practice Address - Phone:916-481-2000
Practice Address - Fax:916-481-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty