Provider Demographics
NPI:1477925972
Name:FIRMALINO-CASTANEDA DENTAL, INC.
Entity Type:Organization
Organization Name:FIRMALINO-CASTANEDA DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:FAYO
Authorized Official - Last Name:FIRMALINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-393-5501
Mailing Address - Street 1:12875 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3221
Mailing Address - Country:US
Mailing Address - Phone:909-393-5501
Mailing Address - Fax:909-393-0781
Practice Address - Street 1:12875 RAMONA AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3221
Practice Address - Country:US
Practice Address - Phone:909-393-5501
Practice Address - Fax:909-393-0781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRMALINO FAMILY DENTISTRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39402305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization