=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558774109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORENZO M PADRON & ANGEL J PINTO DDS & CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2014
-----------------------------------------------------
Last Update Date | 06/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 SECRET RIVER DR
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95831-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-207-5072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 MARSEILLE DR
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95023-7163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-207-5072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ANGEL J PINTO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 831-207-3224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 52103
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------