Provider Demographics
NPI:1619568847
Name:VIRAMONTES VIRAMONTES, EDUARDO (DDS)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:VIRAMONTES VIRAMONTES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 CROSSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-7620
Mailing Address - Country:US
Mailing Address - Phone:323-697-3238
Mailing Address - Fax:
Practice Address - Street 1:17003 BEAR VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1420
Practice Address - Country:US
Practice Address - Phone:760-244-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist