Provider Demographics
NPI:1851838510
Name:TRI VALLEY DENTAL CARE, INC
Entity Type:Organization
Organization Name:TRI VALLEY DENTAL CARE, INC
Other - Org Name:STONERIDGE DENTAL CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-803-9888
Mailing Address - Street 1:6366 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3036
Mailing Address - Country:US
Mailing Address - Phone:925-803-9888
Mailing Address - Fax:
Practice Address - Street 1:6366 CLARK AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3036
Practice Address - Country:US
Practice Address - Phone:925-803-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB38615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty