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General NPI Number Information
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NPI Number | 1831455815
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Entity Type | Organization
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Legal Business Name | PREMIER ORTHODONTIC SPECIALISTS
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 2100 SOLAR DR SUITE 200
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City | OXNARD
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State | CA
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Zip | 93036-2661
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Country | US
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Telephone | 805-485-1111
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Fax | 805-981-7050
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Provider Business Mailing Address
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Address Line | 2100 SOLAR DR SUITE 200
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City | OXNARD
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State | CA
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Zip | 93036-2661
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Country | US
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Telephone | 805-485-1111
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Fax | 805-981-7050
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAGE HUDSON
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Credential | DDS
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Telephone | 805-485-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 46858
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 36249
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License Number State | CA
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