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General NPI Number Information
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NPI Number | 1265962773
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Entity Type | Organization
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Legal Business Name | JORGE H. ZAMUDIO DDS INC.
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Dates
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Enumeration Date | 06/16/2017
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Last Update Date | 06/16/2017
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Provider Practice Location Address
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Address Line | 1410 3RD ST. SUITE 4
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City | RIVERSIDE
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State | CA
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Zip | 92507
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Country | US
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Telephone | 951-686-8783
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Fax | 951-686-8784
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Provider Business Mailing Address
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Address Line | 1410 3RD ST. SUITE 4
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City | RIVERSIDE
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State | CA
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Zip | 92507
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Country | US
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Telephone | 951-686-8783
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Fax | 951-686-8784
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JORGE HERNANDEZ-ZAMUDIO
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Credential |
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Telephone | 951-318-1740
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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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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45873
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License Number State | CA
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