Provider Demographics
NPI:1750552410
Name:RICHARD PORTALUPI DDS, MSD, AND R. SCOTT ANDERSON, DMD, A DENTAL CORP
Entity type:Organization
Organization Name:RICHARD PORTALUPI DDS, MSD, AND R. SCOTT ANDERSON, DMD, A DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-452-1111
Mailing Address - Street 1:2070 PEABODY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6697
Mailing Address - Country:US
Mailing Address - Phone:707-452-1111
Mailing Address - Fax:707-452-0277
Practice Address - Street 1:2070 PEABODY RD STE 700
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6697
Practice Address - Country:US
Practice Address - Phone:707-452-1111
Practice Address - Fax:707-452-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty