Provider Demographics
NPI:1437213279
Name:DIENTES COMMUNITY DENTAL CARE.
Entity Type:Organization
Organization Name:DIENTES COMMUNITY DENTAL CARE.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-464-5420
Mailing Address - Street 1:1830 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1819
Mailing Address - Country:US
Mailing Address - Phone:831-464-5409
Mailing Address - Fax:831-464-5416
Practice Address - Street 1:1830 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1819
Practice Address - Country:US
Practice Address - Phone:831-464-5409
Practice Address - Fax:831-464-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA932861867OtherDUNS
CA090880OtherUDS
CA1818962OtherSTATE CORPORATE NUMBER