Provider Demographics
NPI:1710187349
Name:R A MACASAET DENTAL CORP
Entity Type:Organization
Organization Name:R A MACASAET DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIL
Authorized Official - Middle Name:ALMENDRALA
Authorized Official - Last Name:MACASAET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-881-0501
Mailing Address - Street 1:19100 VENTURA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3234
Mailing Address - Country:US
Mailing Address - Phone:818-881-0501
Mailing Address - Fax:818-881-6393
Practice Address - Street 1:19100 VENTURA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3234
Practice Address - Country:US
Practice Address - Phone:818-881-0501
Practice Address - Fax:818-881-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty