Healthcare Provider Details

I. General information

NPI: 1992121891
Provider Name (Legal Business Name): NARITA DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 03/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 TORRANCE BLVD STE G
TORRANCE CA
90503-5804
US

IV. Provider business mailing address

3465 TORRANCE BLVD STE G
TORRANCE CA
90503-5804
US

V. Phone/Fax

Practice location:
  • Phone: 310-543-7788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41489
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number47136
License Number StateCA

VIII. Authorized Official

Name: MIE NARITA
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 310-543-7788