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General NPI Number Information
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NPI Number | 1568981017
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Entity Type | Organization
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Legal Business Name | SIADATIE A PROF DENTAL CORP
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 3873 STOCKDALE HWY
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City | BAKERSFIELD
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State | CA
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Zip | 93309-2189
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Country | US
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Telephone | 805-377-2222
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Fax | 805-377-2222
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Provider Business Mailing Address
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Address Line | 3873 STOCKDALE HWY
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City | BAKERSFIELD
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State | CA
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Zip | 93309-2189
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Country | US
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Telephone | 661-412-7747
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Fax |
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Authorized Official
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Title or Position | MANAGING DENTIST
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Name | TISA SIADATIE
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Credential | DDS
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Telephone | 661-412-7747
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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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