Provider Demographics
NPI:1700189495
Name:SAN GABRIEL VALLEY FOUNDATION FOR DENTAL HEALTH
Entity Type:Organization
Organization Name:SAN GABRIEL VALLEY FOUNDATION FOR DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-688-6407
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-0099
Mailing Address - Country:US
Mailing Address - Phone:626-688-6407
Mailing Address - Fax:626-934-2893
Practice Address - Street 1:14101 NELSON AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-2640
Practice Address - Country:US
Practice Address - Phone:626-688-6407
Practice Address - Fax:626-934-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-18
Last Update Date:2010-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty