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General NPI Number Information
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NPI Number | 1619187747
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11912 VALLEY BLVD SUITE A
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City | EL MONTE
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State | CA
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Zip | 91732-3153
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Country | US
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Telephone | 626-444-5500
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Fax | 626-444-4041
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Provider Business Mailing Address
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Address Line | 11912 VALLEY BLVD SUITE A
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City | EL MONTE
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State | CA
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Zip | 91732-3153
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Country | US
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Telephone | 626-444-5500
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Fax | 626-444-4041
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARIA C GONZALEZ
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Credential | M.D.
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Telephone | 626-444-5500
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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 | 47081
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License Number State | CA
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