Organization
ALTAVAS DENTAL GROUP, INC.
Active
Other names
Qualident USA LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MYRNA RAMOS ALTAVAS D.D.S. (PRESIDENT)
(661) 343-5018
Entity
Organization
Contact information
Practice address
4100 EMPIRE DRIVE, SUITE 110, BAKERSFIELD, CA 93309
(661) 246-4322
Mailing address
10304 SKILES DRIVE, BAKERSFIELD, CA 93311
(661) 343-5018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
57548
CA
Other
Enumeration date
11/28/2009
Last updated
06/14/2011
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