Provider Demographics
NPI:1073651584
Name:VILLAGO, GLORIANA CO TING KEH (D D S)
Entity Type:Individual
Prefix:DR
First Name:GLORIANA
Middle Name:CO TING KEH
Last Name:VILLAGO
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4863 EAGLE ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2631
Mailing Address - Country:US
Mailing Address - Phone:323-258-3333
Mailing Address - Fax:323-258-3334
Practice Address - Street 1:4863 EAGLE ROCK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2631
Practice Address - Country:US
Practice Address - Phone:323-258-3333
Practice Address - Fax:323-258-3334
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice