1538720354 NPI number — BIODENTAL CARE S.C.

Table of content: (NPI 1538720354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538720354 NPI number — BIODENTAL CARE S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIODENTAL CARE S.C.
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:
1538720354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
641 E SAN YSIDRO BLVD.
Provider Second Line Business Mailing Address:
SUITE # B3-953
Provider Business Mailing Address City Name:
SAN YSIDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92173-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-246-3368
Provider Business Mailing Address Fax Number:
858-430-3143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
C. LUIS CABRERA #2071-301
Provider Second Line Business Practice Location Address:
ZONA URBANA RIO TIJUANA
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
833-246-3368
Provider Business Practice Location Address Fax Number:
858-430-3143
Provider Enumeration Date:
06/24/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUIZ GONZALEZ
Authorized Official First Name:
CESAR
Authorized Official Middle Name:
ALEJANDRO
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
833-246-3368

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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