| NPI | 1497575948 |
|---|---|
| Doing Business As | SACRAMENTO COMMUNITY CLINIC - STOCKTON BLVD DENTAL |
| Entity Type | Organization |
| Authorized Contact | JERRY T BLIATOUT CEO 916-642-1867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2025-02-04 |