Healthcare Provider Details

I. General information

NPI: 1902494602
Provider Name (Legal Business Name): SNOW TEHACHAPI DENTAL OFFICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20878 SAGE LN
TEHACHAPI CA
93561-6423
US

IV. Provider business mailing address

868 AUTO CENTER DR STE C
PALMDALE CA
93551-4691
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4861
  • Fax:
Mailing address:
  • Phone: 661-450-0116
  • Fax: 661-273-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEONOR PINEDA
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 661-450-0116