Provider Demographics
NPI:1700833993
Name:DAS DENTAL GROUP
Entity Type:Organization
Organization Name:DAS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-205-4604
Mailing Address - Street 1:4492 CAMINO DE LA PLZ
Mailing Address - Street 2:SUITE 1166
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3003
Mailing Address - Country:US
Mailing Address - Phone:619-205-4604
Mailing Address - Fax:
Practice Address - Street 1:NETZAHUALCOYOTL #1211
Practice Address - Street 2:SUITE #1 PB
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22415
Practice Address - Country:MX
Practice Address - Phone:664-683-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MX122300000X, 1223E0200X, 1223G0001X, 1223P0221X, 1223X0400X, 124Q00000X, 126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Not Answered126800000XDental ProvidersDental AssistantGroup - Multi-Specialty