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General NPI Number Information
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NPI Number | 1952770455
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Entity Type | Organization
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Legal Business Name | MARIA DIZON DDS INC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 1621 17TH ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-4300
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Country | US
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Telephone | 661-631-0529
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 17TH ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-4300
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Country | US
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Telephone | 661-631-0529
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KAREN J CAMP
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Credential | RDA
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Telephone | 661-631-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 43593
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License Number State | CA
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