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General NPI Number Information
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NPI Number | 1952713950
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Entity Type | Organization
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Legal Business Name | GRDENTISTRY GILBERTO OLAGUEDDSAPROFESSIONALCORPORATION
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Dates
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Enumeration Date | 05/24/2014
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Last Update Date | 05/24/2014
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Provider Practice Location Address
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Address Line | 3559 W RAMSEY ST STE C1
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City | BANNING
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State | CA
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Zip | 92220-3505
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Country | US
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Telephone | 951-922-3993
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Fax | 951-922-3991
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Provider Business Mailing Address
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Address Line | 3559 W RAMSEY ST STE C1
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City | BANNING
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State | CA
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Zip | 92220-3505
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Country | US
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Telephone | 951-922-3993
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Fax | 951-922-3991
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GILBERTO OLAGUE
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Credential | DDS
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Telephone | 805-404-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 59467
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License Number State | CA
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