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General NPI Number Information
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NPI Number | 1316379746
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Entity Type | Organization
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Legal Business Name | CLINICA DE ODONTOLOGIA ESPECIALIZADA
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | CALLE CHIHUAHUA 121
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City | CD. OBREGON
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State | SONORA
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Zip | 85000
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Country | MX
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Telephone | 011526444131314
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12385
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City | EL PASO
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State | TX
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Zip | 79913-0385
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Country | US
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Telephone | 915-726-0929
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAMBERTO MORALES
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Credential | DDS
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Telephone | 011526444131314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1739073
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License Number State | ZZ
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