Provider Demographics
NPI:1700961752
Name:ILAGAN-AVERGONZADO, JESSICA ZENAIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ZENAIDA
Last Name:ILAGAN-AVERGONZADO
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 1:13424 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2629
Mailing Address - Country:US
Mailing Address - Phone:562-804-7580
Mailing Address - Fax:562-804-6294
Practice Address - Street 1:13424 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2629
Practice Address - Country:US
Practice Address - Phone:562-804-7580
Practice Address - Fax:562-804-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice