| Licauco Tan Dental Corp | |
|
30 Centerpointe Dr Suite 10 La Palma CA 90623-1055 | |
| (714) 994-0888 | |
| (714) 994-6038 |
| Full Name | Licauco Tan Dental Corp |
|---|---|
| Speciality | Dentist |
| Location | 30 Centerpointe Dr, La Palma, California |
| Authorized Official Name and Position | Cecile Licauco (PRESIDENT) |
| Authorized Official Contact | 7149940888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Licauco Tan Dental Corp 30 Centerpointe Dr Suite 10 La Palma CA 90623-1055 Ph: (714) 994-0888 | Licauco Tan Dental Corp 30 Centerpointe Dr Suite 10 La Palma CA 90623-1055 Ph: (714) 994-0888 |
| NPI Number | 1952431033 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952431033 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 40656 (California) | Primary |
| 122300000X | Dentist | 41314 (California) | Secondary |
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