Provider Demographics
NPI:1467627943
Name:WILLIAM JUAREZ DENTAL CORP
Entity Type:Organization
Organization Name:WILLIAM JUAREZ DENTAL CORP
Other - Org Name:SUNRISE DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-416-0833
Mailing Address - Street 1:1717 E VISTA CHINO
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-3569
Mailing Address - Country:US
Mailing Address - Phone:760-416-0833
Mailing Address - Fax:760-416-1313
Practice Address - Street 1:1717 E VISTA CHINO
Practice Address - Street 2:SUITE A-5
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3569
Practice Address - Country:US
Practice Address - Phone:760-416-0833
Practice Address - Fax:760-416-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA45272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty