Provider Demographics
NPI:1326462045
Name:VICENTE P. SON, DDS A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:VICENTE P. SON, DDS A PROFESSIONAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-739-0120
Mailing Address - Street 1:3875 WILSHIRE BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3211
Mailing Address - Country:US
Mailing Address - Phone:213-739-0120
Mailing Address - Fax:213-739-0720
Practice Address - Street 1:3875 WILSHIRE BLVD STE 602
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3211
Practice Address - Country:US
Practice Address - Phone:213-739-0120
Practice Address - Fax:213-739-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801810833OtherNATIONAL PLAN & PROVIDER ENUMERATION SYSTEM