=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760678650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCIANE QUEIROZ DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2007
-----------------------------------------------------
Last Update Date | 09/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2160 WHITE LN
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93304-6915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-833-0707
-----------------------------------------------------
Fax | 661-833-0808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2160 WHITE LN
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93304-6915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-833-0707
-----------------------------------------------------
Fax | 661-833-0808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LUCIANE QUEIROZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 661-833-0707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 52674
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------