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General NPI Number Information
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NPI Number | 1245357789
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Entity Type | Organization
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Legal Business Name | UNTALAN DENTAL CORPORATION
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10750 GLENOAKS BLVD SUITE 6
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City | PACOIMA
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State | CA
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Zip | 91331-1690
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Country | US
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Telephone | 818-686-1400
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Fax | 818-686-1411
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Provider Business Mailing Address
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Address Line | 10750 GLENOAKS BLVD SUITE 6
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City | PACOIMA
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State | CA
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Zip | 91331-1690
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Country | US
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Telephone | 818-686-1400
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Fax | 818-686-1411
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Authorized Official
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Title or Position | VP
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Name | DR. CHARISE R UNTALAN II
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Credential |
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Telephone | 213-385-3828
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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 | 49693
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License Number State | CA
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