Provider Demographics
NPI:1689857013
Name:LETICIA R. TOLENTINO, DMD, INC.
Entity Type:Organization
Organization Name:LETICIA R. TOLENTINO, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-522-9769
Mailing Address - Street 1:860 E CARSON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-7940
Mailing Address - Country:US
Mailing Address - Phone:310-522-9769
Mailing Address - Fax:310-522-0119
Practice Address - Street 1:860 E CARSON ST STE 106
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7940
Practice Address - Country:US
Practice Address - Phone:310-522-9769
Practice Address - Fax:310-522-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41798261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental