HENRY VONG PROF DENTAL CORP (NPI# 1639599129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639599129 |
| Entity Type | Organization |
| Organization Name | HENRY VONG PROF DENTAL CORP |
| Other Organization Name | ROSEVILLE DENTAL CENTER |
| Practice Address |
1771 Pleasant Grove Blvd Ste 180 Roseville CA 95747-8720 |
| Practice Telephone | 9167723847 |
| Practice Fax Number | 9162733111 |
| Mailing Telephone | 9167723847 |
| Mailing Fax Number | 9162733111 |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |
| Authorized Official Name | DR. HENRY VONG (PRESIDENT) |
| Authorized Official Telephone | 4155680761 |
| Authorized Official Credential | D.D.S |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
60037 | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Roseville Dental Center | Doing Business As Name - Organization |
| Street Address |
1771 PLEASANT GROVE BLVD STE 180 |
| City | ROSEVILLE |
| State | CA |
| Zip Code | 95747-8720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902104722 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 1771 Pleasant Grove Blvd, Suite 100, Roseville, CA 95747-8720 | 2011-03-02 |
| 1366007247 | Jasmeen Kaur Rana | Pharmacist | 1771 Pleasant Grove Blvd, Roseville, CA 95747-8720 | 2019-05-06 |
| 1871966341 | Maria Theresa Dimen | Pharmacist | 1771 Pleasant Grove Blvd, Roseville, CA 95747-8720 | 2015-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215407051 | Clifford Leo Faubert | Nurse Practitioner | 1937 Ellesmere Loop, Roseville, CA 95747 | 2018-12-04 |
| 1821577172 | Adam Botwinik | Psychologist | 8849 Cook Riolo Road, Roseville, CA 95747 | 2018-08-08 |
| 1093231201 | Heather Mairi Ybarra | Behavior Technician | 4216 Wyman Way, Roseville, CA 95747 | 2017-08-18 |
| 1881114650 | Bridget Bell | Behavior Technician | 8202 Tail Race Dr, Roseville, CA 95747 | 2017-06-22 |
| 1760911192 | Laura Marie Hummel | Massage Therapist | 9077 Foothills Blvd. Suite 200, Roseville, CA 95747 | 2017-06-08 |
| 1184975625 | Whitney Anne Wright | Marriage & Family Therapist | 7517 Locomotive Ln, Roseville, CA 95747 | 2012-09-24 |
| 1962764290 | Panumas Soukaroon | Physical Medicine & Rehabilitation | Glenwood Springs Way, Roseville, CA 95747 | 2012-06-12 |
| 1134487366 | Tatyana Serikov | Dental Hygienist | 616 Treviso Ct, Roseville, CA 95747 | 2012-04-25 |
| 1720352099 | Peggy Holcomb | Clinical Neuropsychologist | 4010 Foothills Bvld., Ste. 103-3, Roseville, CA 95747 | 2012-03-02 |
| 1740577220 | Laina Marie Haider | Occupational Therapist | 7950 Footthills Blvd, The Bridges At Woodcreek Oaks, Roseville, CA 95747 | 2011-07-05 |
| Find all providers in zip 95747 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053935916 | Michael J. Petersen, D.d.s., P.a. | Clinic/Center | 3101 Old Highway 8 Ste 303, Roseville, MN 55113-1076 | 2020-06-05 |
| 1346873288 | Van De Vyver Dental, P.C. | Clinic/Center | 25810 Kelly Rd Ste 2, Roseville, MI 48066-4467 | 2020-02-19 |
| 1518510643 | Ardalan Keshtkar Dds Inc | Clinic/Center | 10 Sierra Gate Plz Ste 130, Roseville, CA 95678-6646 | 2019-07-18 |
| 1659880805 | Gurkamal Sandhu Dds, Inc. | Clinic/Center | 1895 E Roseville Pkwy Ste 100, Roseville, CA 95661-7977 | 2017-09-20 |
| 1457875809 | Khs Pannu Dds Inc | Clinic/Center | 1950 Douglas Blvd Ste B1, Roseville, CA 95661-3827 | 2017-07-27 |
| 1801248950 | Baban Dhariwal Dds Pa Inc | Clinic/Center | 6049 Douglas Blvd Ste 9, Roseville, CA 95746-6249 | 2016-07-12 |
| 1972610046 | Donald E. Clarke, D.d.s., Inc. | Clinic/Center | 2200 Professional Dr, Suite 210, Roseville, CA 95661-7763 | 2006-08-24 |
| 1497352363 | David A. Susko, Dds | Clinic/Center | 20737 E 13 Mile Rd, Roseville, MI 48066-4503 | 2020-10-05 |
| 1396385175 | Bosch Dental Pllc | Clinic/Center | 2680 Snelling Ave N, Roseville, MN 55113-1876 | 2020-01-09 |
| 1790320265 | Richard B Knight Dds Ms Inc | Clinic/Center | 2520 Douglas Blvd Ste 130, Roseville, CA 95661-3993 | 2019-11-08 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.