Provider Demographics
NPI:1558193052
Name:GOOD HABITS DENTAL CARE
Entity type:Organization
Organization Name:GOOD HABITS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQUERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDA
Authorized Official - Phone:714-486-3216
Mailing Address - Street 1:1801 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2332
Mailing Address - Country:US
Mailing Address - Phone:714-486-3216
Mailing Address - Fax:714-486-3220
Practice Address - Street 1:1801 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2332
Practice Address - Country:US
Practice Address - Phone:714-486-3216
Practice Address - Fax:714-486-3220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELVIS BAQUERO DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental