Provider Demographics
NPI:1831321033
Name:PARTI DENTAL CORPORATION
Entity Type:Organization
Organization Name:PARTI DENTAL CORPORATION
Other - Org Name:HEALTHY SMILES KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASALDUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-377-6453
Mailing Address - Street 1:3450 STINE ROAD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6341
Mailing Address - Country:US
Mailing Address - Phone:661-377-6453
Mailing Address - Fax:661-377-7000
Practice Address - Street 1:3450 STINE ROAD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6341
Practice Address - Country:US
Practice Address - Phone:661-377-6453
Practice Address - Fax:661-377-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2010-02-05
Deactivation Date:2009-09-24
Deactivation Code:
Reactivation Date:2010-01-28
Provider Licenses
StateLicense IDTaxonomies
CA419791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty