Provider Demographics
NPI:1629418140
Name:UGARTE DENTAL CORPORATION
Entity Type:Organization
Organization Name:UGARTE DENTAL CORPORATION
Other - Org Name:UGARTE FAMILY DENTISTREY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:UGARTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-953-5340
Mailing Address - Street 1:1913 E 17TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8627
Mailing Address - Country:US
Mailing Address - Phone:714-953-5340
Mailing Address - Fax:714-953-5227
Practice Address - Street 1:1913 E 17TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8627
Practice Address - Country:US
Practice Address - Phone:714-953-5340
Practice Address - Fax:714-953-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty