Provider Demographics
NPI:1972038321
Name:SERGIO PEREIRA & SIMONNE PATRICK, DDS A PROF CORP
Entity Type:Organization
Organization Name:SERGIO PEREIRA & SIMONNE PATRICK, DDS A PROF CORP
Other - Org Name:DESIGN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-714-3344
Mailing Address - Street 1:5700 WHITELOCK PKWY
Mailing Address - Street 2:#120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5925
Mailing Address - Country:US
Mailing Address - Phone:916-714-3344
Mailing Address - Fax:916-714-3304
Practice Address - Street 1:5700 WHITELOCK PKWY
Practice Address - Street 2:#120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5925
Practice Address - Country:US
Practice Address - Phone:916-714-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty