Provider Demographics
NPI:1659893824
Name:DR AMY WOO A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:DR AMY WOO A PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WARUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-443-8955
Mailing Address - Street 1:2627 K ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5103
Mailing Address - Country:US
Mailing Address - Phone:916-443-8955
Mailing Address - Fax:
Practice Address - Street 1:2627 K ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5103
Practice Address - Country:US
Practice Address - Phone:916-443-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty