Provider Demographics
NPI:1861565020
Name:RATON PROF DENTAL CORP
Entity type:Organization
Organization Name:RATON PROF DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ALMONEDA
Authorized Official - Last Name:RATON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-326-3657
Mailing Address - Street 1:24231 CRENSHAW BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5344
Mailing Address - Country:US
Mailing Address - Phone:310-326-3657
Mailing Address - Fax:310-326-4299
Practice Address - Street 1:24231 CRENSHAW BLVD
Practice Address - Street 2:STE E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5344
Practice Address - Country:US
Practice Address - Phone:310-326-3657
Practice Address - Fax:310-326-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty