1083778120 NPI number — ST ANTHONY FAMILY DENTISTRY

Table of content: (NPI 1083778120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083778120 NPI number — ST ANTHONY FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST ANTHONY FAMILY DENTISTRY
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:
1083778120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1323 E MANNING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-643-8448
Provider Business Mailing Address Fax Number:
559-643-8458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1323 E MANNING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-643-8448
Provider Business Practice Location Address Fax Number:
559-643-8458
Provider Enumeration Date:
12/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TOVAR
Authorized Official First Name:
MARTH
Authorized Official Middle Name:
Authorized Official Title or Position:
RECEPTIONIST
Authorized Official Telephone Number:
559-643-8448

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42893 , 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)

  • Identifier: G9204401 . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G9801102 . This is a "HEALTHY FAMILIES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".