Provider Demographics
NPI:1417220732
Name:MARTHA PATRICIA PARROQUIN PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MARTHA PATRICIA PARROQUIN PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PARROQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-960-9966
Mailing Address - Street 1:3709 BALDWIN PARK BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4178
Mailing Address - Country:US
Mailing Address - Phone:626-960-9966
Mailing Address - Fax:626-962-9136
Practice Address - Street 1:3709 BALDWIN PARK BLVD STE J
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4178
Practice Address - Country:US
Practice Address - Phone:626-960-9966
Practice Address - Fax:626-962-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty