1841465945 NPI number — RUBY DACIO DDS & LUTGARDA PEREZ DDS DENTAL CORP

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 1841465945 NPI number — RUBY DACIO DDS & LUTGARDA PEREZ DDS DENTAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUBY DACIO DDS & LUTGARDA PEREZ DDS DENTAL CORP
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:
1841465945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 STOCKDALE HWY
Provider Second Line Business Mailing Address:
SUITE# 500
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93311-3613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-746-4067
Provider Business Mailing Address Fax Number:
661-746-3078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 STOCKDALE HWY
Provider Second Line Business Practice Location Address:
SUITE# 500
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93311-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-654-0758
Provider Business Practice Location Address Fax Number:
661-654-0758
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DACIO
Authorized Official First Name:
RUBY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
661-746-4067

Provider Taxonomy Codes

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

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

  • Identifier: B44243-01 . This is a "HEALTHY FAMILY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G-91807-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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