1891112249 NPI number — ROGER W. ASHWORTH A PROFESSIONAL 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 1891112249 NPI number — ROGER W. ASHWORTH A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER W. ASHWORTH A PROFESSIONAL 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:
SMILE ART DENTAL ARBUCKLE
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:
1891112249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20030 OLD RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95691-8004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-919-1841
Provider Business Mailing Address Fax Number:
530-476-2930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 FIFTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARBUCKLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-476-2219
Provider Business Practice Location Address Fax Number:
530-476-2930
Provider Enumeration Date:
03/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ASHWORTH
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-919-1841

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  25118 , 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)





Copyright © 2007-2024 www.npivalidator.com