Provider Demographics
NPI:1548763808
Name:CLAUDIA VIDES SAMARITANA DENTAL, INC
Entity Type:Organization
Organization Name:CLAUDIA VIDES SAMARITANA DENTAL, INC
Other - Org Name:SAMARITANA DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSAC
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:562-310-6856
Mailing Address - Street 1:510 S ALVARADO ST STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2904
Mailing Address - Country:US
Mailing Address - Phone:213-483-3600
Mailing Address - Fax:
Practice Address - Street 1:510 S ALVARADO ST STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2904
Practice Address - Country:US
Practice Address - Phone:213-483-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty