Individual
BEAUREGARD STORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7237 E SOUTHGATE DR STE E, SACRAMENTO, CA 95823-2637
(916) 836-3833
Mailing address
3500 WESTMINSTER WAY, NAPA, CA 94558-4165
(707) 738-6881
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
104564
CA
1223D0004X
Dental Anesthesiology
Primary
104564
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2019
Last updated
07/01/2024
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