Provider Demographics
NPI:1376940734
Name:PARROQUIN FAMILY DENTAL PRACTICE, INC.
Entity Type:Organization
Organization Name:PARROQUIN FAMILY DENTAL PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PARROQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-763-4040
Mailing Address - Street 1:11335 MAGNOLIA BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4951
Mailing Address - Country:US
Mailing Address - Phone:818-763-4040
Mailing Address - Fax:818-763-4949
Practice Address - Street 1:11335 MAGNOLIA BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4951
Practice Address - Country:US
Practice Address - Phone:818-763-4040
Practice Address - Fax:818-763-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty