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General NPI Number Information
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NPI Number | 1710007877
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Entity Type | Organization
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Legal Business Name | GLORIANA C. VILLAGO D. D. S., INC.
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 4863 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-2631
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Country | US
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Telephone | 323-258-3333
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Fax | 323-258-3334
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Provider Business Mailing Address
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Address Line | 4863 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-2631
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Country | US
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Telephone | 323-258-3333
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Fax | 323-258-3334
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLORIANA CO TING KEH VILLAGO
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Credential | D. D. S.
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Telephone | 323-401-8560
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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 | 48054
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License Number State | CA
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