Provider Demographics
NPI:1477764256
Name:MADERA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MADERA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:QUIROZ
Authorized Official - Last Name:ANGUIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-662-1410
Mailing Address - Street 1:509 S I ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4660
Mailing Address - Country:US
Mailing Address - Phone:559-662-1410
Mailing Address - Fax:550-662-1454
Practice Address - Street 1:509 S I ST
Practice Address - Street 2:SUITE D
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4660
Practice Address - Country:US
Practice Address - Phone:559-662-1410
Practice Address - Fax:550-662-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326254400OtherNATIONAL PROVIDER #
CA515277OtherPROVIDER ID#
CAB40331OtherPROVIDER#