Provider Demographics
NPI:1790798684
Name:BAJO DMD & LIWANAG DMD INC
Entity Type:Organization
Organization Name:BAJO DMD & LIWANAG DMD INC
Other - Org Name:CARSON FAMILY DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR VP
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIWANAG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-835-7088
Mailing Address - Street 1:144 WEST CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-835-4088
Mailing Address - Fax:310-835-8488
Practice Address - Street 1:144 WEST CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-835-4088
Practice Address - Fax:310-835-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38963261QD0000X
CA38027261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental