Provider Demographics
NPI:1417381799
Name:AMERICAN DENTAL IMPLANT CENTER
Entity Type:Organization
Organization Name:AMERICAN DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:626-577-7770
Mailing Address - Street 1:3007 HUNTINGTON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5522
Mailing Address - Country:US
Mailing Address - Phone:626-577-7770
Mailing Address - Fax:626-577-7777
Practice Address - Street 1:3007 HUNTINGTON DR STE 201
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5522
Practice Address - Country:US
Practice Address - Phone:626-577-7770
Practice Address - Fax:626-577-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty