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General NPI Number Information
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NPI Number | 1295908606
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Entity Type | Organization
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Legal Business Name | ENRICO J. RIDEAU A DENTAL CORPORATION DBA PLAZA DENTAL
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 185 W LA HABRA BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5401
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Country | US
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Telephone | 562-697-4455
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Fax | 562-697-8338
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Provider Business Mailing Address
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Address Line | 185 W LA HABRA BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5401
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Country | US
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Telephone | 562-697-4455
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Fax | 562-697-8338
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOEL G ALATORRE
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Credential |
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Telephone | 562-697-4455
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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 | 31690
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License Number State | CA
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