Provider Demographics
NPI:1992117428
Name:NUEVO SMILE DENTAL MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:NUEVO SMILE DENTAL MANAGEMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENDEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-377-4157
Mailing Address - Street 1:29616 NUEVO RD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-9201
Mailing Address - Country:US
Mailing Address - Phone:951-377-4157
Mailing Address - Fax:
Practice Address - Street 1:29616 NUEVO RD
Practice Address - Street 2:SUITE A4
Practice Address - City:NUEVO
Practice Address - State:CA
Practice Address - Zip Code:92567-9201
Practice Address - Country:US
Practice Address - Phone:951-377-4157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty