Provider Demographics
NPI:1548667470
Name:MARITESSA I. MASANGYA DDS, INC.
Entity type:Organization
Organization Name:MARITESSA I. MASANGYA DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITESSA
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:MASANGYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-292-2996
Mailing Address - Street 1:2207 HIGHLAND AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6905
Mailing Address - Country:US
Mailing Address - Phone:619-292-2996
Mailing Address - Fax:619-292-2571
Practice Address - Street 1:2207 HIGHLAND AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6905
Practice Address - Country:US
Practice Address - Phone:619-292-2996
Practice Address - Fax:619-292-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA526520 OFFICE #01OtherDENTI-CAL