Provider Demographics
NPI:1639384258
Name:ABC DENTAL CORPORATION
Entity Type:Organization
Organization Name:ABC DENTAL CORPORATION
Other - Org Name:RONALD E BUHLER DDS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST CORPORATION OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-363-3216
Mailing Address - Street 1:2828 MILLS PARK DRIVE
Mailing Address - Street 2:STE C
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-363-3216
Mailing Address - Fax:916-363-0269
Practice Address - Street 1:2828 MILLS PARK DRIVE SUITE C
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-363-3216
Practice Address - Fax:916-363-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB14246 01OtherMEDICAL DENTAL