1437388253 NPI number — DR. CARLO MARCEL ARREDONDO DDS

Table of content: DR. CARLO MARCEL ARREDONDO DDS (NPI 1437388253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437388253 NPI number — DR. CARLO MARCEL ARREDONDO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARREDONDO
Provider First Name:
CARLO
Provider Middle Name:
MARCEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARREDONDO
Provider Other First Name:
CARLO
Provider Other Middle Name:
MARCEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437388253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 SW CHANDLER AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702-3248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-241-1299
Provider Business Mailing Address Fax Number:
541-797-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 SW CHANDLER AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-241-1299
Provider Business Practice Location Address Fax Number:
541-797-6086
Provider Enumeration Date:
07/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D8423 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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