Provider Demographics
NPI:1336556521
Name:BELINDA S. GRANADA DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BELINDA S. GRANADA DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRANADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-804-7777
Mailing Address - Street 1:14369 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2901
Mailing Address - Country:US
Mailing Address - Phone:562-804-7777
Mailing Address - Fax:
Practice Address - Street 1:14369 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2901
Practice Address - Country:US
Practice Address - Phone:562-804-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-20
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40010261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164514634OtherMEDICAL