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Organization
MANGRUM DENTAL CORPORATION
Active
Organization
MANGRUM DENTAL CORPORATION
Active
Other names
Petaluma Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEBRA A QUACKENBUSH (OFFICE MANAGER)
(707) 762-0067
Entity
Organization
Contact information
Practice address
1430 E WASHINGTON ST, PETALUMA, CA 94954-3631
(707) 762-0067
(707) 762-4782
Mailing address
1430 E WASHINGTON ST, PETALUMA, CA 94954-3631
(707) 762-0067
(707) 762-4782
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44612
CA
Other
Enumeration date
04/15/2009
Last updated
04/15/2009
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