| Untalan Dental Corporation | |
|
730 S Western Ave Suite 202 Los Angeles CA 90005-3193 | |
| (213) 385-3828 | |
| (213) 385-2144 |
| Full Name | Untalan Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 730 S Western Ave, Los Angeles, California |
| Authorized Official Name and Position | Charise R Untalan (VP) |
| Authorized Official Contact | 2133853828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Untalan Dental Corporation 730 S Western Ave Suite 202 Los Angeles CA 90005-3193 Ph: (213) 385-3828 | Untalan Dental Corporation 730 S Western Ave Suite 202 Los Angeles CA 90005-3193 Ph: (213) 385-3828 |
| NPI Number | 1881711281 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881711281 | NPI | - | NPPES |
| B49693-01 | Other | CA | DELTA DENTAL HEALTHY FAMI |
| G9241201 | Other | CA | DENTICAL PROV NUM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 49693 (California) | Primary |
| 1223G0001X | Dentist - General Practice | 49984 (California) | Secondary |
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