Provider Demographics
NPI:1245437649
Name:R. A. MACASAET DENTAL CORPORATION
Entity type:Organization
Organization Name:R. A. MACASAET DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACASAET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-881-0501
Mailing Address - Street 1:19100 VENTURA BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3239
Mailing Address - Country:US
Mailing Address - Phone:818-881-0501
Mailing Address - Fax:
Practice Address - Street 1:19100 VENTURA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3239
Practice Address - Country:US
Practice Address - Phone:818-881-0501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty