=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245889724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SETIAN & SUAREZ DENTAL GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2019
-----------------------------------------------------
Last Update Date | 09/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6542 BRIGHT AVE
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90601-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-693-9263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6542 BRIGHT AVE
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90601-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-693-9263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / DENTIST
-----------------------------------------------------
Name | RICARDO SUAREZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 323-363-7771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------