Provider Demographics
NPI:1487842233
Name:EYNALD A. DUARTE, DDS, INC.
Entity Type:Organization
Organization Name:EYNALD A. DUARTE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EYNALD
Authorized Official - Middle Name:ACEBEDO
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-944-8244
Mailing Address - Street 1:13960 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3503
Mailing Address - Country:US
Mailing Address - Phone:562-944-8244
Mailing Address - Fax:562-944-8155
Practice Address - Street 1:13960 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-3503
Practice Address - Country:US
Practice Address - Phone:562-944-8244
Practice Address - Fax:562-944-8155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYNALD A. DUARTE, DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50596305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization