Murijono Reksoatmodjo, DDS
Individual provider Active NPI General Practice Dentistry · Felton, CA
NPI 1598811481 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1598811481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DDS 36825 (CA)
- Practice address
- 6230 Gushee St
Felton, CA 95018-9129 - Phone
- (831) 335-5324
- Fax
- (831) 335-5928
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS 36825 | CA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DDS 36825 | CA | Yes |
Addresses
Primary practice location
6230 Gushee St
Felton, CA 95018-9129
Mailing address
6230 Gushee St
Felton, CA 95018-9129
Phone (831) 335-5324
Other providers in Felton, CA
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- Playful Strides
- Natalia Poole
- Elisabeth Powell
- Lewis Regen
- Maria L Reyes
- Kathryn Elaine Reynolds
- Ann Makaya Roma
- Jo Romaniello
- Santa Cruz Community Counseling Center, Inc.
All providers in Felton, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.