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General NPI Number Information
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NPI Number | 1659423226
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Entity Type | Organization
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Legal Business Name | MARY H. PATUWO DDS, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/30/2007
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Provider Practice Location Address
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Address Line | 14796 BEACH BLVD
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City | LA MIRADA
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State | CA
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Zip | 90638
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Country | US
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Telephone | 714-562-5402
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Fax | 714-562-0248
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Provider Business Mailing Address
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Address Line | 14796 BEACH BLVD
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City | LA MIRADA
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State | CA
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Zip | 90638
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Country | US
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Telephone | 714-562-5402
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Fax | 714-562-0248
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Authorized Official
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Title or Position | MANAGER
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Name | LUKAS PATUWO
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Credential |
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Telephone | 714-562-5402
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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 |
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License Number State |
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