Provider Demographics
NPI:1679666432
Name:AMEZCUA DENTAL CORPORATION
Entity Type:Organization
Organization Name:AMEZCUA DENTAL CORPORATION
Other - Org Name:MARKET WEST DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEZCUA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-574-9400
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:3290 ARENA BLVD
Practice Address - Street 2:STE. 610
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3003
Practice Address - Country:US
Practice Address - Phone:916-574-9400
Practice Address - Fax:916-574-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty