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General NPI Number Information
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NPI Number | 1023207149
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Entity Type | Organization
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Legal Business Name | MENCITA DABU MASANGKAY DMD INC.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 500 ALFRED NOBEL DR STE 145
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City | HERCULES
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State | CA
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Zip | 94547-1839
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Country | US
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Telephone | 510-741-7788
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Fax | 519-741-7705
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Provider Business Mailing Address
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Address Line | 500 ALFRED NOBEL DR STE 145
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City | HERCULES
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State | CA
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Zip | 94547-1839
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Country | US
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Telephone | 510-741-7788
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Fax | 519-741-7705
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Authorized Official
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Title or Position | DENT/OWNERIST
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Name | DR. MENCITA DABU MASANGKAY
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Credential | DMD
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Telephone | 510-741-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 44028
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License Number State | CA
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