Provider Demographics
NPI:1700904679
Name:PURA MAYOR DMD INC.
Entity type:Organization
Organization Name:PURA MAYOR DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-484-8978
Mailing Address - Street 1:9070 WALKER STREET
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:714-484-8978
Mailing Address - Fax:714-827-7468
Practice Address - Street 1:9070 WALKER STREET
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630
Practice Address - Country:US
Practice Address - Phone:714-484-8978
Practice Address - Fax:714-827-7468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty