Provider Demographics
NPI:1245580778
Name:NARVAEZ DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:NARVAEZ DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:ST. FRANCIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARELVIS
Authorized Official - Middle Name:ALEJANDRINA
Authorized Official - Last Name:NARVAEZ-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-530-3100
Mailing Address - Street 1:1379 WEST PARK WESTERN DR. #517
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2300
Mailing Address - Country:US
Mailing Address - Phone:310-530-3100
Mailing Address - Fax:310-530-3103
Practice Address - Street 1:2055 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1701
Practice Address - Country:US
Practice Address - Phone:310-530-3100
Practice Address - Fax:310-530-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56354302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization