Healthcare Provider Details

I. General information

NPI: 1013508183
Provider Name (Legal Business Name): FIFTH AVENUE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N FIFTH AVENUE SUITE 203
ARCADIA CA
91006
US

IV. Provider business mailing address

51 N FIFTH AVENUE SUITE 203
ARCADIA CA
91006
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-6132
  • Fax:
Mailing address:
  • Phone: 626-357-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMUND SALDANA NATIVIDAD
Title or Position: OWNER
Credential: DDS
Phone: 626-357-6132