Provider Demographics
NPI:1164649034
Name:CAMPUS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CAMPUS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-781-7878
Mailing Address - Street 1:PO BOX 55815
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-0815
Mailing Address - Country:US
Mailing Address - Phone:951-781-7878
Mailing Address - Fax:951-781-8654
Practice Address - Street 1:1825 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5345
Practice Address - Country:US
Practice Address - Phone:951-781-7878
Practice Address - Fax:951-781-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93984-01OtherDENTI-CAL
CAG91951-02OtherHEALTHY FAMILIES