Organization
MARIA DIZON DDS INC
Active
Other names
17th Street Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN J CAMP RDA (MANAGER)
(661) 631-0529
Entity
Organization
Contact information
Practice address
1621 17TH ST, BAKERSFIELD, CA 93301-4300
(661) 631-0529
Mailing address
1621 17TH ST, BAKERSFIELD, CA 93301-4300
(661) 631-0529
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
43593
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43593
DENTAL LISC
CA
Enumeration date
09/15/2015
Last updated
09/15/2015
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