# ELK GROVE MEDICAL & DENTAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235165804
- **Authorized official:** MISS DAVIES ONONIWU (OWNER)
- **Authorized official phone:** (916) 691-4200

## Contact information

- **Practice address:** 8139 ELK GROVE BLVD, SUITE 155, ELK GROVE, CA 95758-5519
- **Practice address phone:** (916) 691-4200
- **Practice address fax:** (916) 691-4245
- **Mailing address:** 8139 ELK GROVE BLVD, SUITE 155, ELK GROVE, CA 95758-5519
- **Mailing address phone:** (916) 691-4200
- **Mailing address fax:** (916) 691-4245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 5395690001 | CA | Yes |

## Other

- **Enumeration date:** 06/24/2006
- **Last updated:** 08/22/2020