Provider Demographics
NPI:1730291832
Name:BEATRIZ VIDALES DDS, INC
Entity Type:Organization
Organization Name:BEATRIZ VIDALES DDS, INC
Other - Org Name:DENTAL FAMILIAR & ORTHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-743-6790
Mailing Address - Street 1:725 N QUINCE ST
Mailing Address - Street 2:101
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1680
Mailing Address - Country:US
Mailing Address - Phone:760-743-6790
Mailing Address - Fax:760-743-2874
Practice Address - Street 1:725 N QUINCE ST
Practice Address - Street 2:101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1680
Practice Address - Country:US
Practice Address - Phone:760-743-6790
Practice Address - Fax:760-743-2874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEATRIZ VIDALES DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45212305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4521201OtherDENTI-CAL ID NUM
CA45212OtherDENTAL LICENCE