Provider Demographics
NPI:1275031775
Name:R PAZ CASANOVA A DENTAL CORPORATION
Entity Type:Organization
Organization Name:R PAZ CASANOVA A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-416-5500
Mailing Address - Street 1:10728 RAMONA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2601
Mailing Address - Country:US
Mailing Address - Phone:626-416-5500
Mailing Address - Fax:626-416-5503
Practice Address - Street 1:10728 RAMONA BLVD STE D
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2601
Practice Address - Country:US
Practice Address - Phone:626-416-5500
Practice Address - Fax:626-416-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50970261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental