Provider Demographics
NPI:1124270137
Name:ASK, KINZER, SIMPSON, AND RODA A PROFESSIONA DENTAL CORP
Entity type:Organization
Organization Name:ASK, KINZER, SIMPSON, AND RODA A PROFESSIONA DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:MIHRAN
Authorized Official - Last Name:ASK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-223-2096
Mailing Address - Street 1:100 FRENCH BAR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2557
Mailing Address - Country:US
Mailing Address - Phone:209-223-2712
Mailing Address - Fax:209-223-2719
Practice Address - Street 1:100 FRENCH BAR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2557
Practice Address - Country:US
Practice Address - Phone:209-223-2712
Practice Address - Fax:209-223-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0339461223G0001X
CA401171223G0001X
CA417811223G0001X
CA269491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty