Provider Demographics
NPI:1669862371
Name:DR. LOURDES S. AQUINO DENTAL CORP.
Entity Type:Organization
Organization Name:DR. LOURDES S. AQUINO DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-7498
Mailing Address - Street 1:14435 SHERMAN WAY
Mailing Address - Street 2:UNIT 107
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2331
Mailing Address - Country:US
Mailing Address - Phone:818-785-7498
Mailing Address - Fax:818-785-7789
Practice Address - Street 1:14435 SHERMAN WAY
Practice Address - Street 2:UNIT 107
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2331
Practice Address - Country:US
Practice Address - Phone:818-785-7498
Practice Address - Fax:818-785-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty