Provider Demographics
NPI:1881107258
Name:A.PELAEZ DDS CORP
Entity type:Organization
Organization Name:A.PELAEZ DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-369-3597
Mailing Address - Street 1:6339 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2031
Mailing Address - Country:US
Mailing Address - Phone:951-369-3597
Mailing Address - Fax:951-369-0487
Practice Address - Street 1:6339 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-369-3597
Practice Address - Fax:951-369-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57724261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental