Provider Demographics
NPI:1134391378
Name:IGNACIO, ERWYN JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:ERWYN
Middle Name:JAY
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1348
Mailing Address - Country:US
Mailing Address - Phone:323-344-0682
Mailing Address - Fax:323-344-0682
Practice Address - Street 1:1739 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1348
Practice Address - Country:US
Practice Address - Phone:323-344-0682
Practice Address - Fax:323-344-0682
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice