Provider Demographics
NPI:1659513281
Name:MARY F. AQUINO, DMD INC.
Entity Type:Organization
Organization Name:MARY F. AQUINO, DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY FELICITY
Authorized Official - Middle Name:TORDECILLA
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-360-0957
Mailing Address - Street 1:16917 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7407
Mailing Address - Country:US
Mailing Address - Phone:818-360-0957
Mailing Address - Fax:818-360-7327
Practice Address - Street 1:16917 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7407
Practice Address - Country:US
Practice Address - Phone:818-360-0957
Practice Address - Fax:818-360-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty