Provider Demographics
NPI:1699127779
Name:CHRISTOPHER MUROLO DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:CHRISTOPHER MUROLO DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MUROLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-584-7790
Mailing Address - Street 1:1330 MEDICAL CENTER DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2901
Mailing Address - Country:US
Mailing Address - Phone:707-584-7790
Mailing Address - Fax:707-584-5056
Practice Address - Street 1:1330 MEDICAL CENTER DR STE 3
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2901
Practice Address - Country:US
Practice Address - Phone:707-584-7790
Practice Address - Fax:707-584-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58974261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental