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General NPI Number Information
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NPI Number | 1164899811
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Entity Type | Organization
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Legal Business Name | CAMARILLO ENDODONTICS
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 3901 LAS POSAS RD SUITE 6
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City | CAMARILLO
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State | CA
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Zip | 93010-1501
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Country | US
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Telephone | 805-484-0555
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Fax | 805-484-0553
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Provider Business Mailing Address
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Address Line | 3901 LAS POSAS RD SUITE 6
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City | CAMARILLO
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State | CA
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Zip | 93010-1501
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Country | US
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Telephone | 805-484-0555
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Fax | 805-484-0553
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHRISTINE D KING
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Credential |
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Telephone | 805-484-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 53046
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 46335
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 36774
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License Number State | CA
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