Organization
PLACER COUNTY COMMUNITY CLINIC
Active
Other names
PLACER DENTAL CLINIC TAHOE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LONG (CLINIC MANAGER)
(530) 886-2910
Entity
Organization
Contact information
Practice address
8665 SALMON AVE, KINGS BEACH, CA 96143-9800
(530) 546-1970
(530) 546-4606
Mailing address
PO BOX 1785, KINGS BEACH, CA 96143-1785
(530) 546-1970
(530) 546-4606
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9260102
—
CA
Enumeration date
04/17/2007
Last updated
06/05/2008
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