Provider Demographics
NPI:1568598167
Name:BLUE PLANET DENTAL, INC
Entity Type:Organization
Organization Name:BLUE PLANET DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TUDOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-658-7201
Mailing Address - Street 1:160 S SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4432
Mailing Address - Country:US
Mailing Address - Phone:951-658-7201
Mailing Address - Fax:951-766-6015
Practice Address - Street 1:160 S SANTA FE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4432
Practice Address - Country:US
Practice Address - Phone:951-658-7201
Practice Address - Fax:951-766-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty