1518103761 NPI number — KENDY SHIRLEY PEREZ DENTAL AST.

Table of content: KENDY SHIRLEY PEREZ DENTAL AST. (NPI 1518103761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518103761 NPI number — KENDY SHIRLEY PEREZ DENTAL AST.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
KENDY
Provider Middle Name:
SHIRLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL AST.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518103761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 WRENWOOD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADERA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93638-1827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-270-2689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 WRENWOOD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADERA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93638-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-270-2686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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