Provider Demographics
NPI:1548545866
Name:CARMONA DENTAL INC.
Entity type:Organization
Organization Name:CARMONA DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUETA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-569-3333
Mailing Address - Street 1:4096 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6147
Mailing Address - Country:US
Mailing Address - Phone:323-569-3333
Mailing Address - Fax:323-569-3334
Practice Address - Street 1:4096 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6147
Practice Address - Country:US
Practice Address - Phone:323-569-3333
Practice Address - Fax:323-569-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA600241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty