| Rosedale Dental Care | |
|
105 E 10th St Azusa CA 91702-2445 | |
| (626) 633-1080 | |
| (626) 633-1096 |
| Full Name | Rosedale Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 105 E 10th St, Azusa, California |
| Authorized Official Name and Position | Reuben Saucedo (PRESIDENT) |
| Authorized Official Contact | 6266331080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rosedale Dental Care 105 E 10th St Azusa CA 91702-2445 Ph: (626) 633-1080 | Rosedale Dental Care 105 E 10th St Azusa CA 91702-2445 Ph: (626) 633-1080 |
| NPI Number | 1700207883 |
|---|---|
| Provider Enumeration Date | 12/17/2013 |
| Last Update Date | 12/17/2013 |
| Medicare PECOS PAC ID | 5597070904 |
|---|---|
| Medicare Enrollment ID | O20150813012094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700207883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 43492 (California) | Primary |
| Provider Name | Reuben Saucedo |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1821141128 PECOS PAC ID: 7012236375 Enrollment ID: I20150507002166 |
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