Provider Demographics
NPI:1538720354
Name:BIODENTAL CARE S.C.
Entity type:Organization
Organization Name:BIODENTAL CARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:RUIZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-246-3368
Mailing Address - Street 1:641 E SAN YSIDRO BLVD.
Mailing Address - Street 2:SUITE # B3-953
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3129
Mailing Address - Country:US
Mailing Address - Phone:833-246-3368
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:C. LUIS CABRERA #2071-301
Practice Address - Street 2:ZONA URBANA RIO TIJUANA
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:833-246-3368
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty