| Organization Name: | PACIFIC HOLISTIC DENTAL, INC. |
| NPI Number: | 1780900480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD SHAPIRO (OWNER/ OPERATOR) |
| Mailing Address: | 530 W Tefft St Nipomo |
| State: | CA US |
| Postal Code: | 934448946 |
| Phone Number: | 8059296814 |
| Fax Number: | 8059292047 |
| NPI Enumeration Date: | 04/20/2010 |
| NPI Last Update Date: | 09/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | 57466 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |