1396991295 NPI number — INTERNATIONAL DENTAL PROVIDERS CORP.

Table of content: (NPI 1396991295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396991295 NPI number — INTERNATIONAL DENTAL PROVIDERS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNATIONAL DENTAL PROVIDERS CORP.
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:
1396991295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1594 WOODLARK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91911-5321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-691-8180
Provider Business Mailing Address Fax Number:
619-691-1201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1594 WOODLARK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-691-8180
Provider Business Practice Location Address Fax Number:
619-691-1201
Provider Enumeration Date:
08/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SERRANO
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-691-8180

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  512443 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104 . This is a "DENTAL HEALTH SERVICES OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1369 . This is a "WESTERN DENTAL SERVICES, INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4048 . This is a "LIBERTY DENTAL PLANS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 325977 . This is a "PACIFIC UNION DENTAL, INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1141 . This is a "SAFEGUARD HEALTH PLANS, INC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1327 . This is a "CALIFORNIA DENTAL NETWORK, INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1185 . This is a "GOLDEN WEST HEALTH PLANS, INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 351398 . This is a "UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 44010 . This is a "PACIFICARE DENTAL & VISION ADMINISTRATORS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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