| Untalan Dental Corporation | |
|
10750 Glenoaks Blvd Suite 6 Pacoima CA 91331-1690 | |
| (818) 686-1400 | |
| (818) 686-1411 |
| Full Name | Untalan Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10750 Glenoaks Blvd, Pacoima, 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 10750 Glenoaks Blvd Suite 6 Pacoima CA 91331-1690 Ph: (818) 686-1400 | Untalan Dental Corporation 10750 Glenoaks Blvd Suite 6 Pacoima CA 91331-1690 Ph: (818) 686-1400 |
| NPI Number | 1245357789 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245357789 | NPI | - | NPPES |
| 249693 | Other | CA | DELTA DENTAL ID NUMB |
| G9241202 | Other | CA | DENTICAL PROV NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 49693 (California) | Primary |
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