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General NPI Number Information
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NPI Number | 1407309602
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Entity Type | Organization
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Legal Business Name | ECHARTE-RODRIGUEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 546 W BADILLO ST STE E
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City | COVINA
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State | CA
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Zip | 91722-3786
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Country | US
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Telephone | 626-331-6666
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Fax | 626-331-6660
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Provider Business Mailing Address
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Address Line | 546 W BADILLO ST STE E
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City | COVINA
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State | CA
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Zip | 91722-3786
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Country | US
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Telephone | 626-331-6666
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Fax | 626-331-6660
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Authorized Official
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Title or Position | DOCTOR- OWNER
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Name | DR. GONZALO ECHARTE
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Credential | DDS
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Telephone | 626-331-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 52379
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License Number State | CA
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