Provider Demographics
NPI:1457482069
Name:PAZ CASANOVA, RODY (DDS)
Entity Type:Individual
Prefix:
First Name:RODY
Middle Name:
Last Name:PAZ CASANOVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3127
Mailing Address - Country:US
Mailing Address - Phone:909-825-2175
Mailing Address - Fax:909-825-0964
Practice Address - Street 1:549 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3127
Practice Address - Country:US
Practice Address - Phone:909-825-2175
Practice Address - Fax:909-825-0964
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50970Medicare ID - Type UnspecifiedDENTI-CAL