Provider Demographics
NPI:1093909731
Name:RITA M. ANTOLIN
Entity Type:Organization
Organization Name:RITA M. ANTOLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:MARIANO
Authorized Official - Last Name:ANTOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-703-1299
Mailing Address - Street 1:21301 SATICOY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5639
Mailing Address - Country:US
Mailing Address - Phone:818-703-1299
Mailing Address - Fax:
Practice Address - Street 1:21301 SATICOY ST
Practice Address - Street 2:SUITE A
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5639
Practice Address - Country:US
Practice Address - Phone:818-703-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty