Provider Demographics
NPI:1497248116
Name:RA AMADOR DENTAL GROUP DDS.INC.
Entity Type:Organization
Organization Name:RA AMADOR DENTAL GROUP DDS.INC.
Other - Org Name:AMADOR DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN ROSELLE
Authorized Official - Middle Name:ALBANIA
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-512-5034
Mailing Address - Street 1:14302 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2905
Mailing Address - Country:US
Mailing Address - Phone:626-512-5034
Mailing Address - Fax:562-351-1693
Practice Address - Street 1:14302 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-2905
Practice Address - Country:US
Practice Address - Phone:562-351-1687
Practice Address - Fax:562-351-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty