Provider Demographics
NPI:1861636086
Name:SIERRA FAMILY DENTISTRY INC.
Entity Type:Organization
Organization Name:SIERRA FAMILY DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O. /DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-283-3947
Mailing Address - Street 1:352 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9466
Mailing Address - Country:US
Mailing Address - Phone:530-283-3947
Mailing Address - Fax:530-283-2126
Practice Address - Street 1:352 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9466
Practice Address - Country:US
Practice Address - Phone:530-283-3947
Practice Address - Fax:530-283-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty