Provider Demographics
NPI:1346681095
Name:UNIDENTAL
Entity type:Organization
Organization Name:UNIDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRAL. PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-591-8550
Mailing Address - Street 1:4364 BONITA ROAD PMB 233
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:619-421-6632
Mailing Address - Fax:619-421-6632
Practice Address - Street 1:10709 MISION DE SAN JAVIER, SUITE 003
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22320
Practice Address - Country:MX
Practice Address - Phone:619-591-8550
Practice Address - Fax:619-421-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty