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Organization
GREENHAVEN FAMILY DENTAL LLC
Active
Organization
GREENHAVEN FAMILY DENTAL LLC
Active
Other names
GreenHaven Family Dental LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME PIELAGO (MANAGING DENTIST/OWNER)
(916) 412-5034
Entity
Organization
Contact information
Practice address
925 SECRET RIVER DR STE A, SACRAMENTO, CA 95831-3465
(916) 421-3815
Mailing address
925 SECRET RIVER DR STE A, SACRAMENTO, CA 95831-3465
(916) 421-3815
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2021
Last updated
02/04/2021
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