1215080452 NPI number — GLENN ONG-VELOSO A DENTAL CORPORATION

Table of content: (NPI 1215080452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215080452 NPI number — GLENN ONG-VELOSO A DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENN ONG-VELOSO A 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:
Provider Other Organization Name Type Code:
6
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:
1215080452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21007 NEMOPHILIA ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CALIFORNIA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93505-1963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-373-1950
Provider Business Mailing Address Fax Number:
760-373-0072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21007 NEMOPHILIA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CALIFORNIA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93505-1963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-373-1950
Provider Business Practice Location Address Fax Number:
760-373-0072
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ONG-VELOSO
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
LANZAR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-373-1950

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)

  • Identifier: B44316-1 . This is a "HEALTHY FAMILIES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G91712-02 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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