Provider Demographics
NPI:1699839720
Name:MACARAIG, MILAGROS JAVIER (DDS)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:JAVIER
Last Name:MACARAIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15228 S. HAWTHORNE BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:310-679-8000
Mailing Address - Fax:310-644-3992
Practice Address - Street 1:15228 S. HAWTHORNE BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-679-8000
Practice Address - Fax:310-644-3992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41756122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist