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Organization
SCEVILLE DENTAL GROUP
Active
Organization
SCEVILLE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY SCEVILLE (OWNER)
(209) 847-8091
Entity
Organization
Contact information
Practice address
1390 W H ST, SUITE D-1, OAKDALE, CA 95361-3570
(209) 847-8091
(209) 847-3314
Mailing address
1390 W H ST STE D, OAKDALE, CA 95361-3529
(209) 847-8091
(209) 847-3314
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
46428
CA
122300000X
Dentist
Primary
51300
CA
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
11/20/2006
Last updated
12/23/2019
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