Provider Demographics
NPI:1417354747
Name:DENTAL SAUZA DENTAL OFFICE
Entity Type:Organization
Organization Name:DENTAL SAUZA DENTAL OFFICE
Other - Org Name:SAMUEL SAUZA D.D.S. INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:SAUZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-743-9003
Mailing Address - Street 1:431 W 13TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-5782
Mailing Address - Country:US
Mailing Address - Phone:760-743-9003
Mailing Address - Fax:760-743-9007
Practice Address - Street 1:431 W 13TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-5782
Practice Address - Country:US
Practice Address - Phone:760-743-9003
Practice Address - Fax:760-743-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty