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Organization
DR. WERNER VISAGE DDS, INC.
Active
Organization
DR. WERNER VISAGE DDS, INC.
Active
Other names
Marconi Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
YURIY TIMONICHEV (ADMIN LEAD)
(916) 487-1468
Entity
Organization
Contact information
Practice address
6440 FAIR OAKS BLVD, CARMICHAEL, CA 95608-4019
(916) 487-7148
(916) 487-1468
Mailing address
6440 FAIR OAKS BLVD, CARMICHAEL, CA 95608-4019
(916) 487-7148
(916) 487-1468
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639622848
NPI1
CA
Enumeration date
08/18/2020
Last updated
11/30/2021
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