Healthcare Provider Details

I. General information

NPI: 1609903368
Provider Name (Legal Business Name): DOMINIC T. LETRONG D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LAKE AVE LOWER LEVEL
PASADENA CA
91101-3540
US

IV. Provider business mailing address

310 S LAKE AVE LOWER LEVEL
PASADENA CA
91101-3540
US

V. Phone/Fax

Practice location:
  • Phone: 626-432-4250
  • Fax: 626-432-4270
Mailing address:
  • Phone: 626-432-4250
  • Fax: 626-432-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: