Provider Demographics
NPI:1225569692
Name:FRANCO DENTAL CORPORATION
Entity Type:Organization
Organization Name:FRANCO DENTAL CORPORATION
Other - Org Name:DENTAL CARE OF LA VERNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PACITA
Authorized Official - Middle Name:DIONISIO
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-482-7830
Mailing Address - Street 1:2321 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3027
Mailing Address - Country:US
Mailing Address - Phone:909-596-1861
Mailing Address - Fax:
Practice Address - Street 1:2321 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3027
Practice Address - Country:US
Practice Address - Phone:909-596-1861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA515489Medicaid