Provider Demographics
NPI:1922303809
Name:SAN ANGEL DENTAL MANAGEMENT COMPANY
Entity Type:Organization
Organization Name:SAN ANGEL DENTAL MANAGEMENT COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIA
Authorized Official - Middle Name:LARISSA
Authorized Official - Last Name:ANCHETA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-927-9050
Mailing Address - Street 1:8720 GARFIELD AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3720
Mailing Address - Country:US
Mailing Address - Phone:562-927-9050
Mailing Address - Fax:562-927-9060
Practice Address - Street 1:8720 GARFIELD AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3720
Practice Address - Country:US
Practice Address - Phone:562-927-9050
Practice Address - Fax:562-927-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478391223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty