| NPI | 1104484807 |
|---|---|
| Doing Business As | SACRAMENTO COMMUNITY CLINIC - SOUTHGATE DENTAL |
| Entity Type | Organization |
| Authorized Contact | JERRY T BLIATOUT CEO 916-428-3788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2021-11-09 |