Provider Demographics
NPI:1205946118
Name:NORZAGARAY, EDWARD MONTENEGRO (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MONTENEGRO
Last Name:NORZAGARAY
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 1:13414 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-3434
Mailing Address - Country:US
Mailing Address - Phone:562-903-1645
Mailing Address - Fax:562-944-4459
Practice Address - Street 1:13414 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3434
Practice Address - Country:US
Practice Address - Phone:562-903-1645
Practice Address - Fax:562-944-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist