Provider Demographics
NPI:1245489863
Name:ROSEMARY E NAVARRO, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ROSEMARY E NAVARRO, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-833-7216
Mailing Address - Street 1:12737 GLENOAKS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4757
Mailing Address - Country:US
Mailing Address - Phone:818-833-7216
Mailing Address - Fax:818-833-8118
Practice Address - Street 1:12737 GLENOAKS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4757
Practice Address - Country:US
Practice Address - Phone:818-833-7216
Practice Address - Fax:818-833-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9212701OtherDENTICAL
CA001313493OtherUNITED CONCORDIA