Provider Demographics
NPI:1497501712
Name:ALTIG DENTAL CORPORATION
Entity type:Organization
Organization Name:ALTIG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ALTIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-676-9999
Mailing Address - Street 1:2530 CAMEO DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9000
Mailing Address - Country:US
Mailing Address - Phone:530-676-9999
Mailing Address - Fax:
Practice Address - Street 1:2530 CAMEO DR
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9000
Practice Address - Country:US
Practice Address - Phone:530-676-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental