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Organization
PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST, INC.
Active
Organization
PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST, INC.
Active
Other names
PDI Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE BELLE TUCKER RN (ADMINISTRATOR/DIRECTOR OF NURSING)
(707) 838-6560
Entity
Organization
Contact information
Practice address
1380 19TH HOLE DR, WINDSOR, CA 95492-7713
(707) 838-6560
(707) 838-8464
Mailing address
1380 19TH HOLE DR, WINDSOR, CA 95492-7713
(707) 838-6560
(707) 838-8464
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
550000658
CA
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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