Provider Demographics
NPI:1003105990
Name:PAZ DENTAL GROUP,INC
Entity Type:Organization
Organization Name:PAZ DENTAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MAG
Authorized Official - Prefix:
Authorized Official - First Name:JENY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-825-2175
Mailing Address - Street 1:705 COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3023
Mailing Address - Country:US
Mailing Address - Phone:909-825-2175
Mailing Address - Fax:909-825-0964
Practice Address - Street 1:705 COLTON AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3023
Practice Address - Country:US
Practice Address - Phone:909-825-2175
Practice Address - Fax:909-825-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty