1730530668 NPI number — RATCHFORD DENTAL PRACTICE OF LOS OSOS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730530668 NPI number — RATCHFORD DENTAL PRACTICE OF LOS OSOS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RATCHFORD DENTAL PRACTICE OF LOS OSOS, 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:
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:
1730530668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 BERNARDO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRO BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93442-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-772-8585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2238 BAYVIEW HEIGHTS DR
Provider Second Line Business Practice Location Address:
STE. N
Provider Business Practice Location Address City Name:
LOS OSOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93402-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-802-4893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RATCHFORD
Authorized Official First Name:
FOREST
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
931-802-4893

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  61353 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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