Provider Demographics
NPI:1528216595
Name:DENTAL CARE OF RANCHO BERNARDO
Entity Type:Organization
Organization Name:DENTAL CARE OF RANCHO BERNARDO
Other - Org Name:DENTAL CARE OF RANCHO BERNARDO, A DENTAL PRACTICE OF AMBROSIO DENTAL C
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNABE BARR
Authorized Official - Middle Name:URBANO
Authorized Official - Last Name:AMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-385-9188
Mailing Address - Street 1:12120 ALTA CARMEL CT
Mailing Address - Street 2:SUITE 410C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3864
Mailing Address - Country:US
Mailing Address - Phone:858-385-9188
Mailing Address - Fax:
Practice Address - Street 1:12120 ALTA CARMEL CT
Practice Address - Street 2:SUITE 410C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3864
Practice Address - Country:US
Practice Address - Phone:858-385-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50720261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental