Provider Demographics
NPI:1487066890
Name:SYNERGY DENTAL MANAGEMENT, INC
Entity type:Organization
Organization Name:SYNERGY DENTAL MANAGEMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-800-7235
Mailing Address - Street 1:3229 SANTA ANITA AVE
Mailing Address - Street 2:#B
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1359
Mailing Address - Country:US
Mailing Address - Phone:626-800-7235
Mailing Address - Fax:626-789-0288
Practice Address - Street 1:3229 SANTA ANITA AVE
Practice Address - Street 2:#B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1359
Practice Address - Country:US
Practice Address - Phone:626-800-7235
Practice Address - Fax:626-789-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental