=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265849038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALELI AMOS PALAGANAS DMD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2014
-----------------------------------------------------
Last Update Date | 07/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1341 E 8TH ST SUITE D
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-474-8441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1341 E 8TH ST SUITE D
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-474-8441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | DR. ARTEMIO FLORES PALAGANAS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 619-474-8441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 57115
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------