| Carmona Dental Inc. | |
|
4096 Tweedy Blvd South Gate CA 90280-6147 | |
| (323) 569-3333 | |
| (323) 569-3334 |
| Full Name | Carmona Dental Inc. |
|---|---|
| Speciality | Dentist |
| Location | 4096 Tweedy Blvd, South Gate, California |
| Authorized Official Name and Position | Enriqueta Carmona (PRESIDENT) |
| Authorized Official Contact | 3235693333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carmona Dental Inc. 4096 Tweedy Blvd South Gate CA 90280-6147 Ph: (323) 569-3333 | Carmona Dental Inc. 4096 Tweedy Blvd South Gate CA 90280-6147 Ph: (323) 569-3333 |
| NPI Number | 1548545866 |
|---|---|
| Provider Enumeration Date | 10/18/2011 |
| Last Update Date | 11/25/2020 |
| Medicare PECOS PAC ID | 2860755352 |
|---|---|
| Medicare Enrollment ID | O20180416001486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548545866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 60024 (California) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | Enriqueta A Carmona |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1578866430 PECOS PAC ID: 7315200813 Enrollment ID: I20180416001731 |
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