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NPI Code Detail

MEDICARE: DIENTES COMMUNITY DENTAL CARE.

MEDICARE: DIENTES COMMUNITY DENTAL CARE.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1932861867OTHERCADUNS
2090880OTHERCAUDS
31818962OTHERCASTATE CORPORATE NUMBER

General Provider Information

NPI Number : 1437213279
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIENTES COMMUNITY DENTAL CARE.
Provider Business Mailing Address
First Line : 1830 COMMERCIAL WAY
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95065-1819
Country : US
Telephone Number : 831-464-5409
Fax Number : 831-464-5416
Provider Business Practice Location Address
First Line : 1830 COMMERCIAL WAY
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95065-1819
Country : US
Telephone Number : 831-464-5409
Fax Number : 831-464-5416
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. LAURA MARCUS
Credential :
Telephone Number : 831-464-5420
Provider Enumeration Date : 12/19/2006
Last Update Date : 06/22/2015

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Directions to “DIENTES COMMUNITY DENTAL CARE. ” Practice Location

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