Provider Demographics
NPI:1720195191
Name:ARCHIBALD, NANCY LEE (DDS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 SUNSET BLVD STE 3E
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3096
Mailing Address - Country:US
Mailing Address - Phone:916-624-5905
Mailing Address - Fax:916-624-0374
Practice Address - Street 1:3101 SUNSET BLVD STE 3E
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3096
Practice Address - Country:US
Practice Address - Phone:916-624-5905
Practice Address - Fax:916-624-0374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice