1679666432 NPI number — AMEZCUA DENTAL CORPORATION

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 1679666432 NPI number — AMEZCUA DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMEZCUA DENTAL CORPORATION
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:
MARKET WEST DENTAL GROUP
Provider Other Organization Name Type Code:
3
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:
1679666432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75392-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-508-3600
Provider Business Mailing Address Fax Number:
714-368-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3290 ARENA BLVD
Provider Second Line Business Practice Location Address:
STE. 610
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95834-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-574-9400
Provider Business Practice Location Address Fax Number:
916-574-9494
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMEZCUA
Authorized Official First Name:
OSVALDO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER DDS
Authorized Official Telephone Number:
916-574-9400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com