Provider Demographics
NPI:1295903557
Name:LARDIZABAL, CHONA SUMAGAYSAY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHONA
Middle Name:SUMAGAYSAY
Last Name:LARDIZABAL
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 1:8935 SAN RAMON RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1061
Mailing Address - Country:US
Mailing Address - Phone:925-300-9559
Mailing Address - Fax:925-524-2485
Practice Address - Street 1:8935 SAN RAMON RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1061
Practice Address - Country:US
Practice Address - Phone:925-300-9559
Practice Address - Fax:925-524-2485
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice