Provider Demographics
NPI:1760810485
Name:DR, VICENTE G. CASIBANG, DDS, INC.
Entity Type:Organization
Organization Name:DR, VICENTE G. CASIBANG, DDS, INC.
Other - Org Name:VALLEY VIEW DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASIBANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-475-8419
Mailing Address - Street 1:123 WORTHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6100
Mailing Address - Country:US
Mailing Address - Phone:619-475-8419
Mailing Address - Fax:619-472-3624
Practice Address - Street 1:123 WORTHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6100
Practice Address - Country:US
Practice Address - Phone:619-475-8419
Practice Address - Fax:619-472-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522496Medicaid
CA522496Medicaid