Provider Demographics
NPI:1003005307
Name:COMMUNITY ORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COMMUNITY ORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-422-6889
Mailing Address - Street 1:128 E ALISAL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3519
Mailing Address - Country:US
Mailing Address - Phone:831-422-6889
Mailing Address - Fax:831-422-6111
Practice Address - Street 1:801 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927-4938
Practice Address - Country:US
Practice Address - Phone:831-674-1570
Practice Address - Fax:831-674-9058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ORAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92048-01OtherDENTI-CAL