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General NPI Number Information
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NPI Number | 1689857013
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Entity Type | Organization
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Legal Business Name | LETICIA R. TOLENTINO, DMD, INC.
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 860 E CARSON ST STE 106
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City | CARSON
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State | CA
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Zip | 90745-7940
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Country | US
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Telephone | 310-522-9769
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Fax | 310-522-0119
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Provider Business Mailing Address
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Address Line | 860 E CARSON ST STE 106
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City | CARSON
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State | CA
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Zip | 90745-7940
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Country | US
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Telephone | 310-522-9769
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Fax | 310-522-0119
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LETICIA R. TOLENTINO
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Credential | DMD
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Telephone | 310-522-9769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 41798
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License Number State | CA
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