1154514388 NPI number — SANFORD L. RATNER DDS AND MONTY C.WILSON DDS INC.

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 1154514388 NPI number — SANFORD L. RATNER DDS AND MONTY C.WILSON DDS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANFORD L. RATNER DDS AND MONTY C.WILSON DDS INC.
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:
1154514388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N TUSTIN AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-835-7771
Provider Business Mailing Address Fax Number:
714-835-1715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N TUSTIN AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-835-7771
Provider Business Practice Location Address Fax Number:
714-835-1715
Provider Enumeration Date:
08/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RATNER
Authorized Official First Name:
SANFORD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT OF CORP.
Authorized Official Telephone Number:
714-835-7771

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  027058 , 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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