Provider Demographics
NPI:1578993705
Name:RAMONA OAK DENTAL
Entity Type:Organization
Organization Name:RAMONA OAK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-219-4860
Mailing Address - Street 1:1721 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2240
Mailing Address - Country:US
Mailing Address - Phone:619-219-4860
Mailing Address - Fax:
Practice Address - Street 1:1721 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2240
Practice Address - Country:US
Practice Address - Phone:619-219-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODOLFO OROZCO, DDS, APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty