Provider Demographics
NPI:1003133109
Name:DON MUNGCAL, D.D.S., INC.
Entity type:Organization
Organization Name:DON MUNGCAL, D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGCAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-620-5777
Mailing Address - Street 1:1213 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4749
Mailing Address - Country:US
Mailing Address - Phone:310-545-5910
Mailing Address - Fax:213-620-8963
Practice Address - Street 1:1213 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4749
Practice Address - Country:US
Practice Address - Phone:310-545-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANHATTAN BEACH DENTAL SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-28
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6296090001Medicare NSC