Provider Demographics
NPI:1821298373
Name:ADVANCED ORAL DIAGNOSIS & TREATMENT CENTER
Entity Type:Organization
Organization Name:ADVANCED ORAL DIAGNOSIS & TREATMENT CENTER
Other - Org Name:ADVANCED ORAL DIAGNOSIS & TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:925-837-8048
Mailing Address - Street 1:400 EL CERRO BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1731
Mailing Address - Country:US
Mailing Address - Phone:925-837-8048
Mailing Address - Fax:925-837-8049
Practice Address - Street 1:400 EL CERRO BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1731
Practice Address - Country:US
Practice Address - Phone:925-837-8048
Practice Address - Fax:925-837-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17881122300000X, 1223X0400X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty