Organization
SISKIYOU HOSPITAL INC
Active
Parent organization
SISKIYOU HOSPITAL INC, DBA FAIRCHILD DENTAL CLINIC
Other names
Fairchild Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SISKIYOU HOSPITAL INC, DBA FAIRCHILD DENTAL CLINIC
Authorized official
JONATHON C ANDRUS (CEO)
(530) 842-4121
Entity
Organization
Contact information
Practice address
475 BRUCE ST, YREKA, CA 96097-3474
(530) 842-3507
(530) 841-6242
Mailing address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 842-4121
(530) 841-6242
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
29114
CA
Other
Enumeration date
01/06/2016
Last updated
01/06/2016
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