Maria Dizon DDS Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

43593 Issued in CA

Legal business name

MARIA DIZON DDS INC

Doing business as

17th Street Dental Care

Practice address

1621 17TH St
Bakersfield, CA 93301-4300

Phone

(661) 631-0529

NPI assigned

Sep 15, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karen J Camp, RDA

Title

Manager

Phone

(661) 631-0529

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• 17th Street Dental Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1952770455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 17TH ST",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933014300",
            "telephone_number": "661-631-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 17TH ST",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933014300",
            "telephone_number": "661-631-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIA DIZON DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "CAMP",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "661-631-0529",
        "authorized_official_credential": "RDA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "43593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LISC",
            "identifier": "43593",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "17th Street Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jose Rene Marentes Sr.
• Abelardo Mares, PA-C
• Vanessa Mares
• PJ Margolis-Fox
• Regina Marguez
• Maricel Isidro-Reighard Nursing Anesthesia Inc
• Susana Marin Pena, LCSW
• Abel Marin
• Alyssa C Marin
• Brenda Marin

• Dental Clinic/Center in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.