Provider Demographics
NPI:1851421416
Name:RC DENTAL PRACTICE
Entity Type:Organization
Organization Name:RC DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZSOLT
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-368-0440
Mailing Address - Street 1:10390 COLOMA ROAD
Mailing Address - Street 2:#A
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-368-0440
Mailing Address - Fax:916-368-1111
Practice Address - Street 1:10390 COLOMA ROAD
Practice Address - Street 2:#A
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-368-0440
Practice Address - Fax:916-368-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9287201Medicaid