Organization
BRENT C. MACKAY D.D.S., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT CALVIN MACKAY D.D.S. (PRESIDENT)
(530) 877-8694
Entity
Organization
Contact information
Practice address
5571 SCOTTWOOD RD, PARADISE, CA 95969-5043
(530) 877-8694
(530) 877-8038
Mailing address
5571 SCOTTWOOD RD, PARADISE, CA 95969-5043
(530) 877-8694
(530) 877-8038
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
25588
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B25588-01
MEDI-CAL DENTAL PROGRAM
CA
Enumeration date
08/22/2007
Last updated
08/22/2007
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