1225519903 NPI number — ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES 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 1225519903 NPI number — ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES 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:
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:
1225519903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20530 E ARROW HWY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91724-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-938-1236
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8363 RESEDA BLVD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-405-0278
Provider Business Practice Location Address Fax Number:
626-938-1238
Provider Enumeration Date:
08/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ROSALES
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
MAGPILI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-938-1236

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  55369 , 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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