Provider Demographics
NPI:1891889291
Name:GORETTI LI DDS INC.
Entity Type:Organization
Organization Name:GORETTI LI DDS INC.
Other - Org Name:ATLANTIC SQUARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GORETTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-888-0681
Mailing Address - Street 1:2176 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6839
Mailing Address - Country:US
Mailing Address - Phone:323-888-0681
Mailing Address - Fax:323-888-0671
Practice Address - Street 1:2176 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6839
Practice Address - Country:US
Practice Address - Phone:323-888-0681
Practice Address - Fax:323-888-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty