Provider Demographics
NPI:1679057186
Name:PN DEQUIROZ DDS INC
Entity type:Organization
Organization Name:PN DEQUIROZ DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARAON
Authorized Official - Middle Name:NOLASCO
Authorized Official - Last Name:DEQUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-815-2835
Mailing Address - Street 1:2503 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1657
Mailing Address - Country:US
Mailing Address - Phone:805-934-4500
Mailing Address - Fax:805-934-5263
Practice Address - Street 1:2503 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1657
Practice Address - Country:US
Practice Address - Phone:805-934-4500
Practice Address - Fax:805-934-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery