Provider Demographics
NPI:1265799753
Name:EDITHA M. AQUINO D.M.D. PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:EDITHA M. AQUINO D.M.D. PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITHA
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-642-3711
Mailing Address - Street 1:2600 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5713
Mailing Address - Country:US
Mailing Address - Phone:707-642-3711
Mailing Address - Fax:707-556-9237
Practice Address - Street 1:2600 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5713
Practice Address - Country:US
Practice Address - Phone:707-642-3711
Practice Address - Fax:707-556-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty