Provider Demographics
NPI:1730238239
Name:NAGTALON, IMELDA PINTADO (DDS)
Entity type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:PINTADO
Last Name:NAGTALON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1175 E JULIAN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1091
Mailing Address - Country:US
Mailing Address - Phone:408-993-8491
Mailing Address - Fax:408-993-0663
Practice Address - Street 1:1175 E JULIAN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1091
Practice Address - Country:US
Practice Address - Phone:408-993-8491
Practice Address - Fax:408-899-2070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA491541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1402304OtherUNITED CONCORDIA
CA7401609OtherDELTA DENTAL
CAG92150-14OtherSTATE GOV. PROGRAM
CAG921514OtherDENTICAL