Provider Demographics
NPI:1962001347
Name:MARIDETTE CUNANAN DDS INC
Entity Type:Organization
Organization Name:MARIDETTE CUNANAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-990-1034
Mailing Address - Street 1:5333 LEMON GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4005
Mailing Address - Country:US
Mailing Address - Phone:360-990-1034
Mailing Address - Fax:
Practice Address - Street 1:3731 WILSHIRE BLVD STE 625
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2824
Practice Address - Country:US
Practice Address - Phone:213-381-3738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental