| Fillmore Dental Group | |
|
1317 W Ventura St Unit C Fillmore CA 93015-1690 | |
| (805) 524-9100 | |
| (805) 524-9500 |
| Full Name | Fillmore Dental Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 1317 W Ventura St Unit C, Fillmore, California |
| Authorized Official Name and Position | Alejandro Echeverry (DENTIST) |
| Authorized Official Contact | 8055249100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fillmore Dental Group 1317 W Ventura St Unit C Fillmore CA 93015-1690 Ph: (805) 524-9100 | Fillmore Dental Group 1317 W Ventura St Unit C Fillmore CA 93015-1690 Ph: (805) 524-9100 |
| NPI Number | 1285893792 |
|---|---|
| Provider Enumeration Date | 06/09/2008 |
| Last Update Date | 11/15/2022 |
| Medicare PECOS PAC ID | 2769850452 |
|---|---|
| Medicare Enrollment ID | O20221130003248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285893792 | NPI | - | NPPES |
| G89695-01 | Other | CA | DENTICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 49876 (California) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Mauricio Fonrodona |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1194822197 PECOS PAC ID: 3678941366 Enrollment ID: I20221130003284 |