Provider Demographics
NPI:1225338270
Name:CHONA S. LARDIZABAL, DDS, INC.
Entity Type:Organization
Organization Name:CHONA S. LARDIZABAL, DDS, INC.
Other - Org Name:WE CARE DENTAL PRACTICE OF CHONA S. LARDIZABAL, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LARDIZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-627-5328
Mailing Address - Street 1:8935 SAN RAMON RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1061
Mailing Address - Country:US
Mailing Address - Phone:925-300-9559
Mailing Address - Fax:925-524-2485
Practice Address - Street 1:8935 SAN RAMON RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1061
Practice Address - Country:US
Practice Address - Phone:925-300-9559
Practice Address - Fax:925-524-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty