Organization
ST. JUDE HOSPITAL, INC.
Active
Other names
St. Jude Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY ROSS RN (VICE PRESIDENT, HEALTHY COMMUNITIES)
(714) 992-3164
Entity
Organization
Contact information
Practice address
7758 KNOTT AVE, BUENA PARK, CA 90620-2420
(714) 522-8723
Mailing address
7758 KNOTT AVE, BUENA PARK, CA 90620-2420
(714) 522-8723
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70894F
—
AR
Enumeration date
04/04/2007
Last updated
11/28/2007
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