Provider Demographics
NPI:1083836837
Name:MARIANO M. ORDONEZ, JR., D.M.D., A DENTAL CORP.
Entity Type:Organization
Organization Name:MARIANO M. ORDONEZ, JR., D.M.D., A DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORELEI
Authorized Official - Middle Name:MONTELIBANO
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-384-2204
Mailing Address - Street 1:2542 W 3RD ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1929
Mailing Address - Country:US
Mailing Address - Phone:213-384-2204
Mailing Address - Fax:213-384-4644
Practice Address - Street 1:2542 W 3RD ST
Practice Address - Street 2:SUITE F
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1929
Practice Address - Country:US
Practice Address - Phone:213-384-2204
Practice Address - Fax:213-384-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty