Provider Demographics
NPI:1184830150
Name:DEL MAR DENTAL GROUP
Entity Type:Organization
Organization Name:DEL MAR DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT.
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-497-8300
Mailing Address - Street 1:1211 N DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-1958
Mailing Address - Country:US
Mailing Address - Phone:559-497-8300
Mailing Address - Fax:
Practice Address - Street 1:1211 N DEL MAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-1958
Practice Address - Country:US
Practice Address - Phone:559-497-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty