Provider Demographics
NPI:1053870287
Name:TAHOE ORAL SURGERY
Entity type:Organization
Organization Name:TAHOE ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:APPELBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:916-296-9006
Mailing Address - Street 1:40165 TRUCKEE AIRPORT RD STE 303
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4108
Mailing Address - Country:US
Mailing Address - Phone:530-541-4042
Mailing Address - Fax:
Practice Address - Street 1:40165 TRUCKEE AIRPORT RD STE 303
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4108
Practice Address - Country:US
Practice Address - Phone:530-541-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033353511Medicaid
CA1215073804Medicaid