Provider Demographics
NPI:1851365043
Name:VIDALES, BEATRIZ (DDS)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:VIDALES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4521201OtherMEDI-CAL IDENTIFICATION #
CA980769OtherUNITED CONCORDIA
CAB4521201OtherHEALTY FAMMILIES ID