Provider Demographics
NPI:1114678455
Name:CALIFORNIA DENTAL TEAM A ZUIDERVELD DENTAL GROUP INC
Entity Type:Organization
Organization Name:CALIFORNIA DENTAL TEAM A ZUIDERVELD DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:ZUIDERVELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-625-9300
Mailing Address - Street 1:182 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-8626
Mailing Address - Country:US
Mailing Address - Phone:717-759-4375
Mailing Address - Fax:717-759-4336
Practice Address - Street 1:136 S ASPEN CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5175
Practice Address - Country:US
Practice Address - Phone:559-625-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty