# DR. WERNER VISAGE DDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Marconi Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043822380
- **Authorized official:** YURIY TIMONICHEV (ADMIN LEAD)
- **Authorized official phone:** (916) 487-1468

## Contact information

- **Practice address:** 6440 FAIR OAKS BLVD, CARMICHAEL, CA 95608-4019
- **Practice address phone:** (916) 487-7148
- **Practice address fax:** (916) 487-1468
- **Mailing address:** 6440 FAIR OAKS BLVD, CARMICHAEL, CA 95608-4019
- **Mailing address phone:** (916) 487-7148
- **Mailing address fax:** (916) 487-1468

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 08/18/2020
- **Last updated:** 11/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1639622848 | NPI1 | CA |