1649746066 NPI number — ROMMEL K BAL DDS A DENTAL CORPORATION

Table of content: (NPI 1649746066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649746066 NPI number — ROMMEL K BAL DDS A DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMMEL K BAL DDS 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:
DIGNITY DENTAL PRACTICE
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:
1649746066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 SAINT MARKS PLZ STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95207-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-957-1244
Provider Business Mailing Address Fax Number:
209-957-2591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 SAINT MARKS PLZ STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95207-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-957-1244
Provider Business Practice Location Address Fax Number:
209-957-2591
Provider Enumeration Date:
10/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAL
Authorized Official First Name:
ROMMEL
Authorized Official Middle Name:
KAUR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-957-1244

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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