Provider Demographics
NPI:1609145994
Name:PAZ CASANOVA DENTAL CORPORATION
Entity Type:Organization
Organization Name:PAZ CASANOVA DENTAL CORPORATION
Other - Org Name:SUNSTAR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-810-0045
Mailing Address - Street 1:525 S AZUSA WAY
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5113
Mailing Address - Country:US
Mailing Address - Phone:626-810-0045
Mailing Address - Fax:626-810-6365
Practice Address - Street 1:525 S AZUSA WAY
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5113
Practice Address - Country:US
Practice Address - Phone:626-810-0045
Practice Address - Fax:626-810-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty