1811175318 NPI number — DR. STELA NINKOVA DIMITROVA-MUNRO I DDS

Table of content: DR. STELA NINKOVA DIMITROVA-MUNRO I DDS (NPI 1811175318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811175318 NPI number — DR. STELA NINKOVA DIMITROVA-MUNRO I DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMITROVA-MUNRO
Provider First Name:
STELA
Provider Middle Name:
NINKOVA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1811175318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2817 E YUCCA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85028-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-996-8066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3435 OCEAN PARK BULV.
Provider Second Line Business Practice Location Address:
SUITE205
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-375-4559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  56296 , 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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