Provider Demographics
NPI:1376635136
Name:MALDONADO, PHILIP BYRON (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:BYRON
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2008
Mailing Address - Country:US
Mailing Address - Phone:626-332-2550
Mailing Address - Fax:
Practice Address - Street 1:151 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2008
Practice Address - Country:US
Practice Address - Phone:626-332-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice