Provider Demographics
NPI:1730117300
Name:ARENA GADE WILKES MILLA MCCLURE DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARENA GADE WILKES MILLA MCCLURE DENTAL CORPORATION
Other - Org Name:BLUE OAK DENTAL ROSEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC HOLDER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-786-6777
Mailing Address - Street 1:15 SIERRA GATE PLZ
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6602
Mailing Address - Country:US
Mailing Address - Phone:916-786-6777
Mailing Address - Fax:916-783-0706
Practice Address - Street 1:15 SIERRA GATE PLZ
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6602
Practice Address - Country:US
Practice Address - Phone:916-786-6777
Practice Address - Fax:916-783-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty