Organization
HEALTH AND LIFE ORGANIZATION, INC.
Active
Other names
Sacramento Community Clinic - Stockton Blvd Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY T BLIATOUT (CEO)
(916) 642-1867
Entity
Organization
Contact information
Practice address
5200 STOCKTON BLVD STE 110, SACRAMENTO, CA 95820-5492
(916) 642-1867
Mailing address
3030 EXPLORER DR, SACRAMENTO, CA 95827-2728
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/10/2024
Last updated
02/04/2025
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