Provider Demographics
NPI:1043414931
Name:DR.M. ZAIDA CARBAJAL DENTAL PRACTICE
Entity Type:Organization
Organization Name:DR.M. ZAIDA CARBAJAL DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:M ZAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-279-2700
Mailing Address - Street 1:611 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3223
Mailing Address - Country:US
Mailing Address - Phone:909-235-4148
Mailing Address - Fax:909-235-4636
Practice Address - Street 1:611 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3223
Practice Address - Country:US
Practice Address - Phone:909-235-4148
Practice Address - Fax:909-235-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41065261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental