Provider Demographics
NPI:1639379803
Name:ARREDONDO,MANUEL DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARREDONDO,MANUEL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-422-6359
Mailing Address - Street 1:293 E ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5421
Mailing Address - Country:US
Mailing Address - Phone:619-422-6359
Mailing Address - Fax:619-422-3796
Practice Address - Street 1:293 E ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5421
Practice Address - Country:US
Practice Address - Phone:619-422-6359
Practice Address - Fax:619-422-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty