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General NPI Number Information
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NPI Number | 1093817421
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Entity Type | Organization
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Legal Business Name | SAN MARCOS ORTHODONTICS PLLC
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 800 W. CHANDLER BLVD STE 5
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City | CHANDLER
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State | AZ
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Zip | 85225-2508
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Country | US
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Telephone | 480-899-1633
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Fax | 480-786-3647
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Provider Business Mailing Address
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Address Line | 800 W. CHANDLER BLVD STE 5
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City | CHANDLER
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State | AZ
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Zip | 85225-2508
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Country | US
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Telephone | 480-899-1633
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Fax | 480-786-3647
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Authorized Official
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Title or Position | OFFICER OWNER
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Name | A PAUL SERRANO
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Credential | DDS
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Telephone | 480-899-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D2814
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D4690
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License Number State | AZ
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