Provider Demographics
NPI:1659586949
Name:FRIENDLY DENTAL CENTER
Entity type:Organization
Organization Name:FRIENDLY DENTAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-279-1172
Mailing Address - Street 1:14607 RAMONA BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3465
Mailing Address - Country:US
Mailing Address - Phone:626-960-5108
Mailing Address - Fax:
Practice Address - Street 1:14607 RAMONA BLVD
Practice Address - Street 2:STE B
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3465
Practice Address - Country:US
Practice Address - Phone:626-960-5108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty