Provider Demographics
NPI:1073763132
Name:MARITONE SUANSING-OLAER, DDS, INC.
Entity Type:Organization
Organization Name:MARITONE SUANSING-OLAER, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:TECSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-257-4086
Mailing Address - Street 1:4867 EAGLE ROCK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2657
Mailing Address - Country:US
Mailing Address - Phone:323-257-4086
Mailing Address - Fax:323-257-4181
Practice Address - Street 1:4867 EAGLE ROCK BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2657
Practice Address - Country:US
Practice Address - Phone:323-257-4086
Practice Address - Fax:323-257-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty