Provider Demographics
NPI:1598267189
Name:OXNARD CHILDRENS DENTAL GROUP
Entity Type:Organization
Organization Name:OXNARD CHILDRENS DENTAL GROUP
Other - Org Name:OXNARD CHILDRENS DENTAL GROUP DBA VENTURA CHILDRENS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-367-6071
Mailing Address - Street 1:451 WEST GONZALES ROAD SUITE 300
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-983-0100
Mailing Address - Fax:805-983-0937
Practice Address - Street 1:5101 TELEGRAPH ROAD SUITE 104
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-765-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OXNARD CHILDRENS DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty