Provider Demographics
NPI:1811155609
Name:MILL ROCK ORAL SURGERY DENTAL GROUP
Entity type:Organization
Organization Name:MILL ROCK ORAL SURGERY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-847-0065
Mailing Address - Street 1:1601 MILL ROCK WAY # A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1315
Mailing Address - Country:US
Mailing Address - Phone:661-847-0065
Mailing Address - Fax:661-847-0068
Practice Address - Street 1:1601 MILL ROCK WAY # A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1315
Practice Address - Country:US
Practice Address - Phone:661-847-0065
Practice Address - Fax:661-847-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental