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General NPI Number Information
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NPI Number | 1003106717
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Entity Type | Organization
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Legal Business Name | PLB CALUGCUGAN/LEGASPI DENTAL CENTER
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 8215 VAN NUYS BLVD STE 302
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4838
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Country | US
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Telephone | 818-786-7986
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Fax |
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Provider Business Mailing Address
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Address Line | 8215 VAN NUYS BLVD STE 302
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4838
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Country | US
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Telephone | 818-786-7986
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RENATO LIMEN CALUGCUGAN
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Credential | D.M.D.
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Telephone | 818-786-7986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40654
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License Number State | CA
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