Basic Information
| Provider Information | |||||||||
| NPI: | 1033527825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VENTRESCA | ||||||||
| FirstName: | DOMINICK | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 E ARROW HWY | ||||||||
| Address2: | UNIT 1402 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917857088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104259180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 140 STONY POINT RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075783118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2014 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 63445 | CA | Y | Dental Providers | Dentist |
No ID Information.