Provider Demographics
NPI:1245441575
Name:LOREDO, CAROLINA POBLETE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:POBLETE
Last Name:LOREDO
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 1:4655 KINGSWELL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4348
Mailing Address - Country:US
Mailing Address - Phone:323-662-2195
Mailing Address - Fax:323-913-3895
Practice Address - Street 1:4655 KINGSWELL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4348
Practice Address - Country:US
Practice Address - Phone:323-662-2195
Practice Address - Fax:323-913-3895
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice