Organization
DR. WERNER VISAGE DDS, INC.
Active
Other names
Marconi Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
YURIY TIMONICHEV (ADMIN LEAD)
(916) 487-1468
Entity
Organization
Contact information
Practice address
6440 FAIR OAKS BLVD, CARMICHAEL, CA 95608-4019
(916) 487-7148
(916) 487-1468
Mailing address
6440 FAIR OAKS BLVD, CARMICHAEL, CA 95608-4019
(916) 487-7148
(916) 487-1468
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639622848
NPI1
CA
Enumeration date
08/18/2020
Last updated
11/30/2021
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