Healthcare Provider Details

I. General information

NPI: 1326974254
Provider Name (Legal Business Name): ACENETH DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W BEVERLY BLVD STE C
MONTEBELLO CA
90640-3971
US

IV. Provider business mailing address

1717 W BEVERLY BLVD STE C
MONTEBELLO CA
90640-3971
US

V. Phone/Fax

Practice location:
  • Phone: 323-482-2010
  • Fax:
Mailing address:
  • Phone: 323-482-2010
  • 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: BRENDA A ESCAMILLA
Title or Position: CEO
Credential: DENTIST
Phone: 323-482-2010