Provider Demographics
NPI:1902494602
Name:SNOW TEHACHAPI DENTAL OFFICE INCORPORATED
Entity Type:Organization
Organization Name:SNOW TEHACHAPI DENTAL OFFICE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-450-0116
Mailing Address - Street 1:868 AUTO CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4691
Mailing Address - Country:US
Mailing Address - Phone:661-450-0116
Mailing Address - Fax:661-273-9572
Practice Address - Street 1:20878 SAGE LN
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-6423
Practice Address - Country:US
Practice Address - Phone:661-822-4861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty