Provider Demographics
NPI:1790838035
Name:LONTOC, CECILIA MARIA JUANA (DMD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:MARIA JUANA
Last Name:LONTOC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 W CARSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3151
Mailing Address - Country:US
Mailing Address - Phone:310-782-6155
Mailing Address - Fax:310-782-6156
Practice Address - Street 1:2275 W CARSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3151
Practice Address - Country:US
Practice Address - Phone:310-782-6155
Practice Address - Fax:310-782-6156
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice