Healthcare Provider Details

I. General information

NPI: 1982974184
Provider Name (Legal Business Name): BUENA DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S VENTURA RD STE. 40
OXNARD CA
93030-6551
US

IV. Provider business mailing address

PO BOX 312 STE. 40
OXNARD CA
93032-0312
US

V. Phone/Fax

Practice location:
  • Phone: 805-382-8000
  • Fax: 805-382-8002
Mailing address:
  • Phone: 805-382-8000
  • Fax: 805-382-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38283
License Number StateCA

VIII. Authorized Official

Name: GUILLERMO FUJIMURA
Title or Position: DENTIST /PARTNER
Credential:
Phone: 805-382-8000