Provider Demographics
NPI:1033289236
Name:MAGALONG, EMMANUEL FERRER (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:FERRER
Last Name:MAGALONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W GARVEY AVE
Mailing Address - Street 2:#101
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-851-0020
Mailing Address - Fax:626-851-0035
Practice Address - Street 1:1415 W GARVEY AVE
Practice Address - Street 2:#101
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-851-0020
Practice Address - Fax:626-851-0035
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice