Provider Demographics
NPI:1306254172
Name:GATEWAY OAKS FAMILY DENTISTRY
Entity type:Organization
Organization Name:GATEWAY OAKS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-649-0249
Mailing Address - Street 1:2550 W EL CAMINO AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3900
Mailing Address - Country:US
Mailing Address - Phone:916-649-0249
Mailing Address - Fax:916-649-0258
Practice Address - Street 1:2550 W EL CAMINO AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3900
Practice Address - Country:US
Practice Address - Phone:916-649-0249
Practice Address - Fax:916-649-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12054842OtherCAQH