Provider Demographics
NPI:1093421679
Name:SAN JOSE DENTAL
Entity Type:Organization
Organization Name:SAN JOSE DENTAL
Other - Org Name:SAN JOSE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMD
Authorized Official - Phone:562-904-1807
Mailing Address - Street 1:2161 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3121
Mailing Address - Country:US
Mailing Address - Phone:562-904-1807
Mailing Address - Fax:
Practice Address - Street 1:2161 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3121
Practice Address - Country:US
Practice Address - Phone:562-904-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty