Provider Demographics
NPI:1609575398
Name:RW IMPLANTS & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:RW IMPLANTS & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIBEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-240-4337
Mailing Address - Street 1:31654 RANCHO VIEJO RD STE I-1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6754
Mailing Address - Country:US
Mailing Address - Phone:949-240-4337
Mailing Address - Fax:949-240-7337
Practice Address - Street 1:31654 RANCHO VIEJO RD STE I-1
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6754
Practice Address - Country:US
Practice Address - Phone:949-240-4337
Practice Address - Fax:949-240-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental