=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487019444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2015
-----------------------------------------------------
Last Update Date | 12/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49621 HARRISON ST
-----------------------------------------------------
City | COACHELLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92236-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-398-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49621 HARRISON ST
-----------------------------------------------------
City | COACHELLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92236-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-398-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | MR. ALBERTO RODRIGUEZ CRUZ
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 760-398-5644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------