Provider Demographics
NPI:1821130477
Name:MONCADA DENTAL CORPORATION
Entity Type:Organization
Organization Name:MONCADA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:G
Authorized Official - Last Name:MONCADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-663-7897
Mailing Address - Street 1:1321 N VERMONT AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-663-7897
Mailing Address - Fax:323-663-7803
Practice Address - Street 1:1321 N VERMONT AVE SUITE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-663-7897
Practice Address - Fax:323-663-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty