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 |