Provider Demographics
NPI:1033433867
Name:SUMABAT DENTAL CORPORATION
Entity Type:Organization
Organization Name:SUMABAT DENTAL CORPORATION
Other - Org Name:SUMABAT DENTAL AT INDIO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMABAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-320-6230
Mailing Address - Street 1:43990 GOLF CENTER PKWY
Mailing Address - Street 2:B-4
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-5001
Mailing Address - Country:US
Mailing Address - Phone:760-347-3767
Mailing Address - Fax:
Practice Address - Street 1:43990 GOLF CENTER PKWY
Practice Address - Street 2:B-4
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-5001
Practice Address - Country:US
Practice Address - Phone:760-347-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMABAT DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-23
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABS42426-3OtherDENTI-CAL