Provider Demographics
NPI:1023571650
Name:VIRGINIA IPAPO-AGUSTIN DDS INC
Entity Type:Organization
Organization Name:VIRGINIA IPAPO-AGUSTIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:IPAPO
Authorized Official - Last Name:AGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-336-4453
Mailing Address - Street 1:525 N AZUSA AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-4261
Mailing Address - Country:US
Mailing Address - Phone:626-336-4453
Mailing Address - Fax:
Practice Address - Street 1:525 N AZUSA AVE STE 112
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4261
Practice Address - Country:US
Practice Address - Phone:626-336-4453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty