Provider Demographics
NPI:1144605775
Name:CAMARILLO SPRINGS DENTAL
Entity Type:Organization
Organization Name:CAMARILLO SPRINGS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-388-3008
Mailing Address - Street 1:816 CAMARILLO SPRINGS RD STE L
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9441
Mailing Address - Country:US
Mailing Address - Phone:805-388-3008
Mailing Address - Fax:805-388-5033
Practice Address - Street 1:816 CAMARILLO SPRINGS RD STE L
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9441
Practice Address - Country:US
Practice Address - Phone:805-388-3008
Practice Address - Fax:805-388-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty