1518666049 NPI number — RODEF DENTAL OFFICE OF SANTA CLARITA

Table of content: (NPI 1518666049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518666049 NPI number — RODEF DENTAL OFFICE OF SANTA CLARITA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODEF DENTAL OFFICE OF SANTA CLARITA
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:
CHILDRENS DENTAL FUNZONE
Provider Other Organization Name Type Code:
3
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:
1518666049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2235A E. GARVEY AVE N.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91791-1540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-412-0200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16658 SOLEDAD CANYON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91387-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-412-0200
Provider Business Practice Location Address Fax Number:
661-383-0047
Provider Enumeration Date:
02/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
RODEF
Authorized Official First Name:
FAIRBORZ
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
626-412-0200

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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