Provider Demographics
NPI:1750431516
Name:CELIA P. OCTOMAN, DMD, INC.
Entity type:Organization
Organization Name:CELIA P. OCTOMAN, DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:PONCE
Authorized Official - Last Name:OCTOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-353-9930
Mailing Address - Street 1:2023 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2417
Mailing Address - Country:US
Mailing Address - Phone:213-353-9930
Mailing Address - Fax:
Practice Address - Street 1:2023 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2417
Practice Address - Country:US
Practice Address - Phone:213-353-9930
Practice Address - Fax:213-353-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD30490OtherDENTICAL