=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962562074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENISE A ZENDEJAS DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9150 CAMPO ROAD
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-469-3993
-----------------------------------------------------
Fax | 619-469-3992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9150 CAMPO ROAD
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-469-3993
-----------------------------------------------------
Fax | 619-469-3992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST PRESIDENT
-----------------------------------------------------
Name | DR. DENISE A ZENDEJAS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 619-469-3993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 45635
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------