Provider Demographics
NPI:1710662036
Name:MARIO AMIDI DENTAL GROUP INC
Entity Type:Organization
Organization Name:MARIO AMIDI DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-357-1158
Mailing Address - Street 1:3700 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6433
Mailing Address - Country:US
Mailing Address - Phone:805-486-6305
Mailing Address - Fax:
Practice Address - Street 1:3700 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6433
Practice Address - Country:US
Practice Address - Phone:805-486-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty