Provider Demographics
NPI:1407238058
Name:LIBRADA CALAYAG, DMD, INC
Entity Type:Organization
Organization Name:LIBRADA CALAYAG, DMD, INC
Other - Org Name:ALAMO DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIBRADA
Authorized Official - Middle Name:TAYAO
Authorized Official - Last Name:CALAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-448-8881
Mailing Address - Street 1:3057 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6300
Mailing Address - Country:US
Mailing Address - Phone:707-448-8881
Mailing Address - Fax:
Practice Address - Street 1:3057 ALAMO DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6300
Practice Address - Country:US
Practice Address - Phone:707-448-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBRADA CALAYAG, DMD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization