Provider Demographics
NPI:1548567274
Name:PLAZA DENTAL GROUP
Entity Type:Organization
Organization Name:PLAZA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-965-0971
Mailing Address - Street 1:17515 COLIMA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1859
Mailing Address - Country:US
Mailing Address - Phone:626-965-0971
Mailing Address - Fax:626-965-5785
Practice Address - Street 1:17515 COLIMA RD
Practice Address - Street 2:SUITE C
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1859
Practice Address - Country:US
Practice Address - Phone:626-965-0971
Practice Address - Fax:626-965-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty