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General NPI Number Information
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NPI Number | 1124384417
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Entity Type | Organization
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Legal Business Name | BLACK AND TO DENTAL CORPORATION
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 1509 HAWTHORNE BLVD SUITE 102
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3957
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Country | US
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Telephone | 310-376-5252
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Fax | 310-376-5757
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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Authorized Official
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Title or Position | DDS-OWNER
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Name | DR. JOAN THANH TO
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Credential |
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Telephone | 310-376-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53880
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License Number State | CA
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