1700962347 NPI number — CUMMINGS, BALASANIAN, CAPUTO & NICHOLLS DENTAL GROUP, INC.

Table of content: (NPI 1700962347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700962347 NPI number — CUMMINGS, BALASANIAN, CAPUTO & NICHOLLS DENTAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMMINGS, BALASANIAN, CAPUTO & NICHOLLS DENTAL GROUP, 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:
1700962347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26302 LA PAZ RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-5313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-596-7000
Provider Business Mailing Address Fax Number:
949-586-0158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26302 LA PAZ RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-596-7000
Provider Business Practice Location Address Fax Number:
949-586-0158
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-760-1600

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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