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General NPI Number Information
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NPI Number | 1609145994
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Entity Type | Organization
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Legal Business Name | PAZ CASANOVA DENTAL CORPORATION
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 525 S AZUSA WAY
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City | LA PUENTE
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State | CA
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Zip | 91744-5113
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Country | US
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Telephone | 626-810-0045
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Fax | 626-810-6365
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Provider Business Mailing Address
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Address Line | 525 S AZUSA WAY
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City | LA PUENTE
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State | CA
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Zip | 91744-5113
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Country | US
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Telephone | 626-810-0045
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Fax | 626-810-6365
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RODY PAZ CASANOVA
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Credential | DDS
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Telephone | 626-810-0045
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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 | 50970
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License Number State | CA
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