Provider Demographics
NPI:1417261132
Name:EVEREST DENTAL CARE INC
Entity Type:Organization
Organization Name:EVEREST DENTAL CARE INC
Other - Org Name:EVEREST DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN POCHOLO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-423-5860
Mailing Address - Street 1:PO BOX 17665
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-3665
Mailing Address - Country:US
Mailing Address - Phone:323-423-5860
Mailing Address - Fax:
Practice Address - Street 1:2050 S. CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:323-423-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty