Provider Demographics
NPI:1891126355
Name:VIZCONDE DENTAL CORPORATION
Entity Type:Organization
Organization Name:VIZCONDE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:VIZCONDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-228-1230
Mailing Address - Street 1:5771 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2044
Mailing Address - Country:US
Mailing Address - Phone:714-228-1230
Mailing Address - Fax:714-228-0580
Practice Address - Street 1:5771 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2044
Practice Address - Country:US
Practice Address - Phone:714-228-1230
Practice Address - Fax:714-228-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty