Provider Demographics
NPI:1932250495
Name:ERGINA, C DANETTE ESMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:C DANETTE
Middle Name:ESMAS
Last Name:ERGINA
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 1:12610 DEL AMO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1923
Mailing Address - Country:US
Mailing Address - Phone:562-860-9180
Mailing Address - Fax:562-865-0011
Practice Address - Street 1:12610 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1923
Practice Address - Country:US
Practice Address - Phone:562-860-9180
Practice Address - Fax:562-865-0011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice