Provider Demographics
NPI:1164767125
Name:KALIKA-IVERSON CORP.
Entity Type:Organization
Organization Name:KALIKA-IVERSON CORP.
Other - Org Name:IMAGE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS. COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANI
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-783-5239
Mailing Address - Street 1:101 RALEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8352
Mailing Address - Country:US
Mailing Address - Phone:530-671-2940
Mailing Address - Fax:
Practice Address - Street 1:101 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8352
Practice Address - Country:US
Practice Address - Phone:530-671-2940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372831223P0221X
CA458861223X0400X
334731223X0400X
CA334731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty