Provider Demographics
NPI:1861938474
Name:UTIBE EFFIOM DDS, INC.
Entity type:Organization
Organization Name:UTIBE EFFIOM DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UTIBE
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFIOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-397-1064
Mailing Address - Street 1:PO BOX 341935
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-8983
Mailing Address - Country:US
Mailing Address - Phone:310-397-1064
Mailing Address - Fax:
Practice Address - Street 1:3991 S WESTERN AVE
Practice Address - Street 2:#7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1193
Practice Address - Country:US
Practice Address - Phone:310-397-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty