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General NPI Number Information
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NPI Number | 1356716203
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC AND DENTAL CLINIC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | AVE JUSTO SIERRA # 26 LOCAL 12-A C.C. LA PLAZITA
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City | MEXICALI
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State | BAJA CALIFORNIA
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Zip | 21200
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Country | MX
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Telephone | 686-565-6710
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Fax | 686-565-6711
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Provider Business Mailing Address
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Address Line | 477 CESAR CHAVEZ BLVD STE 9
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City | CALEXICO
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State | CA
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Zip | 92231-2129
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Country | US
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Telephone | 760-890-4142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALBERTO VENEGAS RODRIGUEZ
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Credential |
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Telephone | 760-890-4142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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