Provider Demographics
NPI:1386856201
Name:EL DORADO DENTAL
Entity Type:Organization
Organization Name:EL DORADO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDRIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-462-2049
Mailing Address - Street 1:1211 N EL DORADO STREET
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202
Mailing Address - Country:US
Mailing Address - Phone:209-462-2049
Mailing Address - Fax:
Practice Address - Street 1:1211 N EL DORADO STREET
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202
Practice Address - Country:US
Practice Address - Phone:209-462-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty