Provider Demographics
NPI:1093266785
Name:AYALA ARIZMENDI DENTAL CORPORATION
Entity Type:Organization
Organization Name:AYALA ARIZMENDI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:AYALA ARIZMENDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-774-3000
Mailing Address - Street 1:624 S EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1234
Mailing Address - Country:US
Mailing Address - Phone:714-774-3000
Mailing Address - Fax:714-776-9000
Practice Address - Street 1:624 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1234
Practice Address - Country:US
Practice Address - Phone:714-774-3000
Practice Address - Fax:714-776-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49794122300000X
CA610471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty