Provider Demographics
NPI:1831273002
Name:NIRUYISPC
Entity type:Organization
Organization Name:NIRUYISPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRUYI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-320-0246
Mailing Address - Street 1:3037 MARTHA DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2934
Mailing Address - Country:US
Mailing Address - Phone:805-656-6911
Mailing Address - Fax:805-643-2671
Practice Address - Street 1:3037 MARTHA DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2934
Practice Address - Country:US
Practice Address - Phone:805-656-6911
Practice Address - Fax:805-643-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5292122300000X
CA56796302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No122300000XDental ProvidersDentistGroup - Single Specialty