Provider Demographics
NPI:1013187046
Name:PATRICK Y CHALLITA, DDS, INC
Entity Type:Organization
Organization Name:PATRICK Y CHALLITA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHALLITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-355-2211
Mailing Address - Street 1:717 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1940
Mailing Address - Country:US
Mailing Address - Phone:626-355-2211
Mailing Address - Fax:
Practice Address - Street 1:717 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-1940
Practice Address - Country:US
Practice Address - Phone:626-355-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty