Provider Demographics
NPI:1891066262
Name:DAO REFELA DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:DAO REFELA DENTAL PARTNERSHIP
Other - Org Name:MONROVIA DENTALCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-699-0775
Mailing Address - Street 1:831 E HUNTINGTON DR
Mailing Address - Street 2:STE 201
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3612
Mailing Address - Country:US
Mailing Address - Phone:626-359-8300
Mailing Address - Fax:626-359-8311
Practice Address - Street 1:831 E HUNTINGTON DR
Practice Address - Street 2:STE 201
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3612
Practice Address - Country:US
Practice Address - Phone:626-359-8300
Practice Address - Fax:626-359-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596251223G0001X
CA539021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty