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General NPI Number Information
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NPI Number | 1124319652
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Entity Type | Organization
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Legal Business Name | ATIENZA FAMILY DENTAL CORPORATION
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 37070 NEWARK BLVD STE C
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City | NEWARK
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State | CA
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Zip | 94560-3798
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Country | US
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Telephone | 510-793-2665
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Fax | 510-793-2695
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Provider Business Mailing Address
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Address Line | 37070 NEWARK BLVD STE C
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City | NEWARK
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State | CA
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Zip | 94560-3798
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Country | US
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Telephone | 510-793-2665
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Fax | 510-793-2695
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Authorized Official
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Title or Position | OWNER
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Name | DR. REGIS M ATIENZA JR.
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Credential | DMD
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Telephone | 510-205-6151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40786
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License Number State | CA
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