Provider Demographics
NPI:1982013066
Name:RATCHFORD DENTAL PRACTICE, INC
Entity Type:Organization
Organization Name:RATCHFORD DENTAL PRACTICE, INC
Other - Org Name:MORRO BAY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:CROWN
Authorized Official - Last Name:RATCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-802-4893
Mailing Address - Street 1:747 BERNARDO AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2339
Mailing Address - Country:US
Mailing Address - Phone:805-772-8585
Mailing Address - Fax:
Practice Address - Street 1:747 BERNARDO AVE
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2339
Practice Address - Country:US
Practice Address - Phone:805-772-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225471311OtherPERSONAL NPI NUMBER