Provider Demographics
NPI:1760509905
Name:NORWALK PLAZA DENTISTRY INC
Entity Type:Organization
Organization Name:NORWALK PLAZA DENTISTRY INC
Other - Org Name:NORWALK PLAZA DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-929-3083
Mailing Address - Street 1:11033 EAST ROSECRAWS AVENUE
Mailing Address - Street 2:STE D
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-929-3083
Mailing Address - Fax:562-929-0113
Practice Address - Street 1:11033 EAST ROSECRAWS AVENUE
Practice Address - Street 2:STE D
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-929-3083
Practice Address - Fax:562-929-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty