Provider Demographics
NPI:1407309602
Name:ECHARTE-RODRIGUEZ DENTAL CORPORATION
Entity Type:Organization
Organization Name:ECHARTE-RODRIGUEZ DENTAL CORPORATION
Other - Org Name:ECHARTE-RODRIGUEZ FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHARTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-331-6666
Mailing Address - Street 1:546 W BADILLO ST STE E
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3786
Mailing Address - Country:US
Mailing Address - Phone:626-331-6666
Mailing Address - Fax:626-331-6660
Practice Address - Street 1:546 W BADILLO ST STE E
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3786
Practice Address - Country:US
Practice Address - Phone:626-331-6666
Practice Address - Fax:626-331-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty