Provider Demographics
NPI:1326410135
Name:QUIJANO DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:QUIJANO DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE GRACE
Authorized Official - Middle Name:CATALAN
Authorized Official - Last Name:QUIJANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-270-5309
Mailing Address - Street 1:430 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1602
Mailing Address - Country:US
Mailing Address - Phone:213-270-5309
Mailing Address - Fax:
Practice Address - Street 1:430 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1602
Practice Address - Country:US
Practice Address - Phone:213-270-5309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty