Provider Demographics
NPI:1891848842
Name:DUARTE, EYNALD ACEBEDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EYNALD
Middle Name:ACEBEDO
Last Name:DUARTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13960 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3503
Mailing Address - Country:US
Mailing Address - Phone:562-944-8244
Mailing Address - Fax:562-944-8155
Practice Address - Street 1:13960 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-3503
Practice Address - Country:US
Practice Address - Phone:562-944-8244
Practice Address - Fax:562-944-8155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50596OtherLICENCE NUMBER