Provider Demographics
NPI:1285458620
Name:PAOLO A POIDMORE, DDS, MSD, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:PAOLO A POIDMORE, DDS, MSD, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:POIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-259-9255
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 E BIDWELL ST STE 250
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3586
Practice Address - Country:US
Practice Address - Phone:916-259-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAOLO A POIDMORE, DDS, MSD, A PROFESSIONAL DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty