1780878538 NPI number — CAMINO RAMON DENTAL

Table of content: (NPI 1780878538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780878538 NPI number — CAMINO RAMON DENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMINO RAMON DENTAL
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:
1780878538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 CAMINO RAMON
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
SAN RAMON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94583-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-830-0888
Provider Business Mailing Address Fax Number:
925-830-0988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 CAMINO RAMON
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-830-0888
Provider Business Practice Location Address Fax Number:
925-830-0988
Provider Enumeration Date:
09/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
925-830-0888

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  50281 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305R00000X , with the licence number: 50298 , 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)

  • Identifier: 50298 . This is a "MICHAEL LAI, D.D.S." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 50281 . This is a "DAVID JOU, D.D.S." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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