Organization
PLACER COUNTY COMMUNITY CLINIC
Active
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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