Provider Demographics
NPI:1396991295
Name:INTERNATIONAL DENTAL PROVIDERS CORP.
Entity type:Organization
Organization Name:INTERNATIONAL DENTAL PROVIDERS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-691-8180
Mailing Address - Street 1:1594 WOODLARK CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5321
Mailing Address - Country:US
Mailing Address - Phone:619-691-8180
Mailing Address - Fax:619-691-1201
Practice Address - Street 1:1594 WOODLARK CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5321
Practice Address - Country:US
Practice Address - Phone:619-691-8180
Practice Address - Fax:619-691-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ512443261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104OtherDENTAL HEALTH SERVICES OF CALIFORNIA
CA1369OtherWESTERN DENTAL SERVICES, INC
CA4048OtherLIBERTY DENTAL PLANS OF CALIFORNIA
CA325977OtherPACIFIC UNION DENTAL, INC
CA1141OtherSAFEGUARD HEALTH PLANS, INC.
CA1327OtherCALIFORNIA DENTAL NETWORK, INC
CA1185OtherGOLDEN WEST HEALTH PLANS, INC
CA351398OtherUNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC
CA44010OtherPACIFICARE DENTAL & VISION ADMINISTRATORS