Provider Demographics
NPI:1144048661
Name:MARISSA M CARVALHO DDS INC
Entity type:Organization
Organization Name:MARISSA M CARVALHO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-458-6007
Mailing Address - Street 1:4318 W 165TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2926
Mailing Address - Country:US
Mailing Address - Phone:310-408-9585
Mailing Address - Fax:
Practice Address - Street 1:2780 SKYPARK DR STE 240
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5341
Practice Address - Country:US
Practice Address - Phone:424-458-6007
Practice Address - Fax:424-337-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty