Provider Demographics
NPI:1659647469
Name:DENTAL SERVICES, D.D.S.
Entity Type:Organization
Organization Name:DENTAL SERVICES, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQUEROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-417-5163
Mailing Address - Street 1:2892 N BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 281
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1125
Mailing Address - Country:US
Mailing Address - Phone:888-417-5163
Mailing Address - Fax:
Practice Address - Street 1:2892 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 281
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1125
Practice Address - Country:US
Practice Address - Phone:888-417-5163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty