Organization
GREENHAVEN FAMILY DENTAL LLC
Active
Other names
GreenHaven Family Dental LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME PIELAGO (MANAGING DENTIST/OWNER)
(916) 412-5034
Entity
Organization
Contact information
Practice address
925 SECRET RIVER DR STE A, SACRAMENTO, CA 95831-3465
(916) 421-3815
Mailing address
925 SECRET RIVER DR STE A, SACRAMENTO, CA 95831-3465
(916) 421-3815
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2021
Last updated
02/04/2021
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