Provider Demographics
NPI:1386944460
Name:DENTAL DYNAMIC SERVICES, INC.
Entity type:Organization
Organization Name:DENTAL DYNAMIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PACIFICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPANAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-517-5999
Mailing Address - Street 1:5752 LONETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-3734
Mailing Address - Country:US
Mailing Address - Phone:916-469-3613
Mailing Address - Fax:916-434-6384
Practice Address - Street 1:5752 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3734
Practice Address - Country:US
Practice Address - Phone:916-469-3613
Practice Address - Fax:916-434-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty