Provider Demographics
NPI:1760862189
Name:G C DELAOSA AND R P CASANOVA DDS DENTAL CORP.
Entity type:Organization
Organization Name:G C DELAOSA AND R P CASANOVA DDS DENTAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:H/R
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-579-4274
Mailing Address - Street 1:4161 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1966
Mailing Address - Country:US
Mailing Address - Phone:626-579-4274
Mailing Address - Fax:626-579-4294
Practice Address - Street 1:4161 TYLER AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1966
Practice Address - Country:US
Practice Address - Phone:626-579-4274
Practice Address - Fax:626-579-4294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty