Provider Demographics
NPI:1780790014
Name:TOLENTINO, LETICIA RIVERA (DDS)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:RIVERA
Last Name:TOLENTINO
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 1:860 E CARSON ST
Mailing Address - Street 2:STE 106
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-522-9769
Mailing Address - Fax:310-522-0119
Practice Address - Street 1:860 E CARSON ST
Practice Address - Street 2:STE 106
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-522-9769
Practice Address - Fax:310-522-0119
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice