1265783088 NPI number — P.A. DABIR DDS & Z.E.S. CUISIA

Table of content: DR. KIMBERLY ANN HENNON MD (NPI 1548260573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265783088 NPI number — P.A. DABIR DDS & Z.E.S. CUISIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P.A. DABIR DDS & Z.E.S. CUISIA
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:
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:
1265783088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3257 CAMINO DE LOS COCHES
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92009-8974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-633-1131
Provider Business Mailing Address Fax Number:
760-633-1551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3257 CAMINO DE LOS COCHES
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92009-8974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-633-1131
Provider Business Practice Location Address Fax Number:
760-633-1551
Provider Enumeration Date:
09/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DABIR
Authorized Official First Name:
PRIYADARSHAN
Authorized Official Middle Name:
ASHOK
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
760-633-1131

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  49739 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 49740 , 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)





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