1043399645 NPI number — COMPREHENSIVE DENTAL PRACTICE ORTHODONTICS & IMPLANTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043399645 NPI number — COMPREHENSIVE DENTAL PRACTICE ORTHODONTICS & IMPLANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE DENTAL PRACTICE ORTHODONTICS & IMPLANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NOEL M. & IRMA R. DELOS REYES, D.M.D., INC.
Provider Other Organization Name Type Code:
5
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:
1043399645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2236 GIRARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93215-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-721-3656
Provider Business Mailing Address Fax Number:
661-721-3655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2236 GIRARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93215-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-721-3656
Provider Business Practice Location Address Fax Number:
661-721-3655
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DELOS REYES
Authorized Official First Name:
NOEL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DENTIST/PRESIDENT
Authorized Official Telephone Number:
661-721-3656

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  38668 , 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: B38668-01 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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