Organization
A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD HENRY PORTALUPI D.D.S., M.S.D (OWNER)
(530) 662-9191
Entity
Organization
Contact information
Practice address
1204 COTTONWOOD ST, SUITE 1, WOODLAND, CA 95695-4362
(530) 662-9191
(530) 662-3568
Mailing address
1204 COTTONWOOD ST, SUITE 1, WOODLAND, CA 95695-4362
(530) 662-9191
(530) 662-3568
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DDS25066
CA
Other
Enumeration date
05/09/2007
Last updated
02/15/2008
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