Provider Demographics
NPI:1396922472
Name:MARIA REGALADO, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARIA REGALADO, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA CAROLINA
Authorized Official - Middle Name:DE LEON
Authorized Official - Last Name:REGALADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-402-9196
Mailing Address - Street 1:21010 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2126
Mailing Address - Country:US
Mailing Address - Phone:562-402-9196
Mailing Address - Fax:562-402-9186
Practice Address - Street 1:21010 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-2126
Practice Address - Country:US
Practice Address - Phone:562-402-9196
Practice Address - Fax:562-402-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty