Provider Demographics
NPI:1568776284
Name:QUEIROZ DENTAL INC
Entity Type:Organization
Organization Name:QUEIROZ DENTAL INC
Other - Org Name:MASTERPIECE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-323-7440
Mailing Address - Street 1:207 H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2911
Mailing Address - Country:US
Mailing Address - Phone:661-323-7440
Mailing Address - Fax:661-323-5145
Practice Address - Street 1:207 H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2911
Practice Address - Country:US
Practice Address - Phone:661-323-7440
Practice Address - Fax:661-323-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52674261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental