# DIAMOND SPRINGS DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pleasant Valley Dental, General Dental Practice of Mitchell A. Goodis,
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235377623
- **Authorized official:** DR. MITCHELL A GOODIS DDS (DENTIST)
- **Authorized official phone:** (530) 344-0290

## Contact information

- **Practice address:** 540 MAIN STREET, STE. 102 POST OFFICE BOX 500, DIAMOND SPRINGS, CA 95619-0500
- **Practice address phone:** (530) 344-0290
- **Practice address fax:** (530) 344-0291
- **Mailing address:** PO BOX 500, STE. 102, DIAMOND SPRINGS, CA 95619-0500
- **Mailing address phone:** (530) 344-0290
- **Mailing address fax:** (530) 344-0291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D43010 | CA | Yes |

## Other

- **Enumeration date:** 01/23/2009
- **Last updated:** 10/04/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 130082 | UMITED CONCORDIA | CA |