Provider Demographics
NPI:1174775910
Name:RODY PAZ CASANOVA DDS, INC
Entity type:Organization
Organization Name:RODY PAZ CASANOVA DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-695-3230
Mailing Address - Street 1:2313 MEADOWGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-8610
Mailing Address - Country:US
Mailing Address - Phone:909-920-6740
Mailing Address - Fax:
Practice Address - Street 1:43057 MARGARITA RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3541
Practice Address - Country:US
Practice Address - Phone:951-695-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty