Provider Demographics
NPI:1588706402
Name:PAEZ, ROS GIDEON (DMD)
Entity type:Individual
Prefix:DR
First Name:ROS
Middle Name:GIDEON
Last Name:PAEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 CALLE DEL PACIFICO
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-3020
Mailing Address - Country:US
Mailing Address - Phone:213-413-2111
Mailing Address - Fax:213-413-5125
Practice Address - Street 1:116 N ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5303
Practice Address - Country:US
Practice Address - Phone:213-413-2111
Practice Address - Fax:213-413-5025
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice