1699778258 NPI number — DR. JANICE RENE WORK DDS

Table of content: DR. JANICE RENE WORK DDS (NPI 1699778258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699778258 NPI number — DR. JANICE RENE WORK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORK
Provider First Name:
JANICE
Provider Middle Name:
RENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699778258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 582880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95758-2880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-422-6671
Provider Business Mailing Address Fax Number:
916-422-2928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9045 BRUCEVILLE RD
Provider Second Line Business Practice Location Address:
STE 180
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-683-7336
Provider Business Practice Location Address Fax Number:
916-683-7340
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  37045 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 386-3523-1 . This is a "EDD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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