MEDICARE: AGUILAR RIOS DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1104511625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGUILAR RIOS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	9320 ELK GROVE BLVD STE 170
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-5061
Country	:	US
Telephone Number	:	916-714-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	9320 ELK GROVE BLVD STE 170
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-5061
Country	:	US
Telephone Number	:	916-714-5422
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CARLOS FERNANDO AGUILAR RIOS
Credential	:	DDS
Telephone Number	:	916-714-5422

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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