Provider Demographics
NPI:1982904355
Name:DIAZ AGUDA AND DUMULO GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:DIAZ AGUDA AND DUMULO GENERAL PARTNERSHIP
Other - Org Name:JADE FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PARTNER-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCELI
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-638-9999
Mailing Address - Street 1:13212 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1737
Mailing Address - Country:US
Mailing Address - Phone:714-638-9999
Mailing Address - Fax:714-638-0697
Practice Address - Street 1:13212 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1737
Practice Address - Country:US
Practice Address - Phone:714-638-9999
Practice Address - Fax:714-638-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty