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General NPI Number Information
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NPI Number | 1043399645
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE DENTAL PRACTICE ORTHODONTICS & IMPLANTS
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 2236 GIRARD ST
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City | DELANO
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State | CA
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Zip | 93215-3808
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Country | US
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Telephone | 661-721-3656
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Fax | 661-721-3655
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Provider Business Mailing Address
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Address Line | 2236 GIRARD ST
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City | DELANO
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State | CA
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Zip | 93215-3808
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Country | US
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Telephone | 661-721-3656
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Fax | 661-721-3655
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. NOEL M. DELOS REYES
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Credential | D.M.D.
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Telephone | 661-721-3656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38668
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License Number State | CA
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