Provider Demographics
NPI:1780878538
Name:CAMINO RAMON DENTAL
Entity type:Organization
Organization Name:CAMINO RAMON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-830-0888
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-830-0888
Mailing Address - Fax:925-830-0988
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-830-0888
Practice Address - Fax:925-830-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50281305R00000X
CA50298305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50298OtherMICHAEL LAI, D.D.S.
CA50281OtherDAVID JOU, D.D.S.