Healthcare Provider Details

I. General information

NPI: 1740468339
Provider Name (Legal Business Name): ARTEAGA DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14607 RAMONA BLVD STE B
BALDWIN PARK CA
91706-3465
US

IV. Provider business mailing address

14607 RAMONA BLVD STE B
BALDWIN PARK CA
91706-3465
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-5108
  • Fax: 626-337-1318
Mailing address:
  • Phone: 626-960-5108
  • Fax: 626-337-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48222
License Number StateCA

VIII. Authorized Official

Name: DR. ANAMARIA ARTEAGA
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 626-960-5108