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General NPI Number Information
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NPI Number | 1376940734
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Entity Type | Organization
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Legal Business Name | PARROQUIN FAMILY DENTAL PRACTICE, INC.
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 11335 MAGNOLIA BLVD STE 1B
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-4951
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Country | US
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Telephone | 818-763-4040
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Fax | 818-763-4949
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Provider Business Mailing Address
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Address Line | 11335 MAGNOLIA BLVD STE 1B
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-4951
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Country | US
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Telephone | 818-763-4040
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Fax | 818-763-4949
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Authorized Official
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Title or Position | PRESIDENT/ DENTIST
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Name | MARTHA PATRICIA PARROQUIN
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Credential | DDS
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Telephone | 818-763-4040
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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 | 56576
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License Number State | CA
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