1255403846 NPI number — COMMUNITY DENTAL SERVICES

Table of content: (NPI 1255403846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255403846 NPI number — COMMUNITY DENTAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY DENTAL SERVICES
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:
1255403846
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:
2 MACARTHUR PL
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92707-5924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-708-5308
Provider Business Mailing Address Fax Number:
714-708-5399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 SHAW AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93612-3950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-323-1776
Provider Business Practice Location Address Fax Number:
559-323-4301
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALCIDO
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACT SUPERVISOR
Authorized Official Telephone Number:
714-708-5308

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com