Provider Demographics
NPI:1134253255
Name:SANGA-FORBES, EMALYN BERNABE (DDS)
Entity type:Individual
Prefix:DR
First Name:EMALYN
Middle Name:BERNABE
Last Name:SANGA-FORBES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14649 VICTORY BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4187
Mailing Address - Country:US
Mailing Address - Phone:818-779-2120
Mailing Address - Fax:818-779-2138
Practice Address - Street 1:14649 VICTORY BLVD STE 21
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-4187
Practice Address - Country:US
Practice Address - Phone:818-779-2120
Practice Address - Fax:818-779-2138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice