1790232205 NPI number — ISMILE DENTAL GROUP OF REBECCA S. AHLERS, DDS. INC.

Table of content: (NPI 1790232205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790232205 NPI number — ISMILE DENTAL GROUP OF REBECCA S. AHLERS, DDS. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISMILE DENTAL GROUP OF REBECCA S. AHLERS, DDS. 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:
SURF CITY FAMILY DENTISTRY
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:
1790232205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18377 BEACH BLVD STE 328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-602-6327
Provider Business Mailing Address Fax Number:
714-602-6275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18377 BEACH BLVD STE 328
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-602-6327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
AHLERS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
OWNER DENTIST/PRESIDENT
Authorized Official Telephone Number:
714-602-6327

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  34569 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com