Provider Demographics
NPI:1376903054
Name:MILAGROS J. MACARAIG DDS INC
Entity Type:Organization
Organization Name:MILAGROS J. MACARAIG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:MACARAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-679-8000
Mailing Address - Street 1:15228 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2138
Mailing Address - Country:US
Mailing Address - Phone:310-679-8000
Mailing Address - Fax:310-644-3992
Practice Address - Street 1:15228 HAWTHORNE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2138
Practice Address - Country:US
Practice Address - Phone:310-679-8000
Practice Address - Fax:310-644-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty