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General NPI Number Information
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NPI Number | 1144605775
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Entity Type | Organization
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Legal Business Name | CAMARILLO SPRINGS DENTAL
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 816 CAMARILLO SPRINGS RD STE L
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City | CAMARILLO
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State | CA
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Zip | 93012-9441
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Country | US
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Telephone | 805-388-3008
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Fax | 805-388-5033
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Provider Business Mailing Address
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Address Line | 816 CAMARILLO SPRINGS RD STE L
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City | CAMARILLO
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State | CA
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Zip | 93012-9441
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Country | US
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Telephone | 805-388-3008
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Fax | 805-388-5033
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MICHELLE PEDONE
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Credential |
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Telephone | 805-388-3008
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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 | 64693
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License Number State | CA
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