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General NPI Number Information
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NPI Number | 1073763132
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Entity Type | Organization
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Legal Business Name | MARITONE SUANSING-OLAER, DDS, INC.
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 4867 EAGLE ROCK BLVD STE A
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City | LOS ANGELES
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State | CA
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Zip | 90041-2657
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Country | US
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Telephone | 323-257-4086
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Fax | 323-257-4181
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Provider Business Mailing Address
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Address Line | 4867 EAGLE ROCK BLVD STE A
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City | LOS ANGELES
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State | CA
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Zip | 90041-2657
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Country | US
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Telephone | 323-257-4086
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Fax | 323-257-4181
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Authorized Official
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Title or Position | TREATMENT COORDINATOR
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Name | MRS. VIVIAN V. TECSON
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Credential |
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Telephone | 323-257-4086
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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 | 55264
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License Number State | CA
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