Provider Demographics
NPI:1184836009
Name:BAUTISTA ORIEL DENTAL, INC.
Entity Type:Organization
Organization Name:BAUTISTA ORIEL DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:BAUTISTA
Authorized Official - Last Name:ORIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-468-1168
Mailing Address - Street 1:11960 E. ARTESIA BLVD.
Mailing Address - Street 2:STE 200
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4039
Mailing Address - Country:US
Mailing Address - Phone:562-468-1168
Mailing Address - Fax:562-468-1158
Practice Address - Street 1:11960 E. ARTESIA BLVD.
Practice Address - Street 2:STE 200
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4039
Practice Address - Country:US
Practice Address - Phone:562-468-1168
Practice Address - Fax:562-468-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization