Provider Demographics
NPI:1508218207
Name:OXNARD ENDODONTICS
Entity Type:Organization
Organization Name:OXNARD ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-827-5300
Mailing Address - Street 1:215 DORIS AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4900
Mailing Address - Country:US
Mailing Address - Phone:805-617-0624
Mailing Address - Fax:
Practice Address - Street 1:215 DORIS AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4900
Practice Address - Country:US
Practice Address - Phone:805-617-0624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty