Healthcare Provider Details

I. General information

NPI: 1689857013
Provider Name (Legal Business Name): LETICIA R. TOLENTINO, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E CARSON ST STE 106
CARSON CA
90745-7940
US

IV. Provider business mailing address

860 E CARSON ST STE 106
CARSON CA
90745-7940
US

V. Phone/Fax

Practice location:
  • Phone: 310-522-9769
  • Fax: 310-522-0119
Mailing address:
  • Phone: 310-522-9769
  • Fax: 310-522-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number41798
License Number StateCA

VIII. Authorized Official

Name: DR. LETICIA R. TOLENTINO
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 310-522-9769