Provider Demographics
NPI:1063267748
Name:SAN ANTONIO DENTAL INC
Entity type:Organization
Organization Name:SAN ANTONIO DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-981-1437
Mailing Address - Street 1:PO BOX 7800
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92615-7800
Mailing Address - Country:US
Mailing Address - Phone:714-717-9113
Mailing Address - Fax:562-981-1438
Practice Address - Street 1:4342 ATLANTIC AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2829
Practice Address - Country:US
Practice Address - Phone:562-981-1437
Practice Address - Fax:562-981-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental