Provider Demographics
NPI:1467686279
Name:AMERICAN DENTAL CARE
Entity Type:Organization
Organization Name:AMERICAN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-449-8589
Mailing Address - Street 1:PO BOX 12385
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0385
Mailing Address - Country:US
Mailing Address - Phone:915-449-8589
Mailing Address - Fax:915-996-9913
Practice Address - Street 1:ZARAGOZA Y MEXICO STE 1
Practice Address - Street 2:
Practice Address - City:PUERTO PALOMAS
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:31830
Practice Address - Country:MX
Practice Address - Phone:01152656-666-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3841436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty