Provider Demographics
NPI:1447538228
Name:DFDD CLINICAL SERVICES
Entity type:Organization
Organization Name:DFDD CLINICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-832-6555
Mailing Address - Street 1:42900 BOB HOPE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4442
Mailing Address - Country:US
Mailing Address - Phone:760-832-6555
Mailing Address - Fax:
Practice Address - Street 1:42900 BOB HOPE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4442
Practice Address - Country:US
Practice Address - Phone:760-832-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT FRIENDS OF THE DEVELOPMENTALLY DISABLED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty