=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275090946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATKINSON DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2019
-----------------------------------------------------
Last Update Date | 02/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25339 CAMINO DE CHAMISAL
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93908-8927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-484-5204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25339 CAMINO DE CHAMISAL
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93908-8927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-484-5204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. STANLEY WAYNE ATKINSON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 831-484-5294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------