Organization
PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST, INC.
Active
Other names
PDI Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE BELLE TUCKER RN (ADMINISTRATOR/DIRECTOR OF NURSING)
(707) 838-6560
Entity
Organization
Contact information
Practice address
1380 19TH HOLE DR, WINDSOR, CA 95492-7713
(707) 838-6560
(707) 838-8464
Mailing address
1380 19TH HOLE DR, WINDSOR, CA 95492-7713
(707) 838-6560
(707) 838-8464
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
550000658
CA
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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