Provider Demographics
NPI:1033319538
Name:THE PEDIATRIC DENTAL CENTER
Entity Type:Organization
Organization Name:THE PEDIATRIC DENTAL CENTER
Other - Org Name:FRANASCO ROMERO DDS MSD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONIJEAN
Authorized Official - Middle Name:KEKOOLANI
Authorized Official - Last Name:GARRIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-477-6235
Mailing Address - Street 1:222 CHALAN SANTO PAPA STE 301
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-477-6235
Mailing Address - Fax:671-477-6237
Practice Address - Street 1:222 CHALAN SANTO PAPA STE 301
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-477-6235
Practice Address - Fax:671-477-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD 6111223P0221X
GUD 9921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty