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General NPI Number Information
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NPI Number | 1568598167
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Entity Type | Organization
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Legal Business Name | BLUE PLANET DENTAL, INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 160 S SANTA FE ST
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City | HEMET
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State | CA
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Zip | 92543-4432
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Country | US
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Telephone | 951-658-7201
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Fax | 951-766-6015
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Provider Business Mailing Address
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Address Line | 160 S SANTA FE ST
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City | HEMET
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State | CA
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Zip | 92543-4432
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Country | US
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Telephone | 951-658-7201
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Fax | 951-766-6015
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Authorized Official
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Title or Position | OWNER
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Name | JULIAN M TUDOSE
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Credential | D.D.S.
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Telephone | 951-658-7201
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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 | 49821
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License Number State | CA
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