Provider Demographics
NPI:1336209600
Name:CARINA A. DIZON DMD,APC
Entity Type:Organization
Organization Name:CARINA A. DIZON DMD,APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIZON-JOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-255-1700
Mailing Address - Street 1:3756 W AVENUE 40
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3665
Mailing Address - Country:US
Mailing Address - Phone:323-255-1700
Mailing Address - Fax:323-255-1829
Practice Address - Street 1:3756 W AVENUE 40
Practice Address - Street 2:SUITE 1C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3665
Practice Address - Country:US
Practice Address - Phone:323-255-1700
Practice Address - Fax:323-255-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty