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General NPI Number Information
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NPI Number | 1265799753
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Entity Type | Organization
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Legal Business Name | EDITHA M. AQUINO D.M.D. PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 2600 SPRINGS RD
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City | VALLEJO
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State | CA
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Zip | 94591-5713
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Country | US
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Telephone | 707-642-3711
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Fax | 707-556-9237
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Provider Business Mailing Address
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Address Line | 2600 SPRINGS RD
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City | VALLEJO
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State | CA
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Zip | 94591-5713
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Country | US
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Telephone | 707-642-3711
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Fax | 707-556-9237
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Authorized Official
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Title or Position | DIRECTOR
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Name | EDITHA MENDOZA AQUINO
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Credential | D.M.D.
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Telephone | 707-642-3711
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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 |
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License Number State |
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