Provider Demographics
NPI:1043399645
Name:COMPREHENSIVE DENTAL PRACTICE ORTHODONTICS & IMPLANTS
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTAL PRACTICE ORTHODONTICS & IMPLANTS
Other - Org Name:NOEL M. & IRMA R. DELOS REYES, D.M.D., INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-721-3656
Mailing Address - Street 1:2236 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-3808
Mailing Address - Country:US
Mailing Address - Phone:661-721-3656
Mailing Address - Fax:661-721-3655
Practice Address - Street 1:2236 GIRARD ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3808
Practice Address - Country:US
Practice Address - Phone:661-721-3656
Practice Address - Fax:661-721-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38668-01OtherDENTI-CAL