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General NPI Number Information
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NPI Number | 1679057186
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Entity Type | Organization
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Legal Business Name | PN DEQUIROZ DDS INC
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 2503 PROFESSIONAL PKWY
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City | SANTA MARIA
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State | CA
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Zip | 93455-1657
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Country | US
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Telephone | 805-934-4500
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Fax | 805-934-5263
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Provider Business Mailing Address
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Address Line | 2503 PROFESSIONAL PKWY
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City | SANTA MARIA
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State | CA
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Zip | 93455-1657
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Country | US
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Telephone | 805-934-4500
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Fax | 805-934-5263
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PARAON NOLASCO DEQUIROZ
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Credential | DDS
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Telephone | 760-815-2835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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