Provider Demographics
NPI:1124231345
Name:DABALUS SAULOG DENTAL CORPORATION
Entity Type:Organization
Organization Name:DABALUS SAULOG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ZENAIDA
Authorized Official - Middle Name:UY
Authorized Official - Last Name:SAULOG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-989-9652
Mailing Address - Street 1:4102 ORANGE AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-989-9652
Mailing Address - Fax:562-988-0445
Practice Address - Street 1:4102 ORANGE AVE
Practice Address - Street 2:STE 120
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-989-9652
Practice Address - Fax:562-988-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370931223G0001X
CA399061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty