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General NPI Number Information
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NPI Number | 1447622329
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Entity Type | Organization
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Legal Business Name | BEATRIZ VIDALES DDS ORTHODONTICS, INC
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 744 GRAND AVE
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City | SAN MARCOS
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State | CA
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Zip | 92078-1225
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Country | US
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Telephone | 760-744-0004
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Fax | 760-744-0001
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Provider Business Mailing Address
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Address Line | 744 GRAND AVE
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City | SAN MARCOS
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State | CA
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Zip | 92078-1225
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Country | US
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Telephone | 760-744-0004
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Fax | 760-744-0001
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Authorized Official
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Title or Position | DENTIST
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Name | BEATRIZ VIDALES
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Credential |
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Telephone | 760-744-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 45212
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License Number State | CA
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