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General NPI Number Information
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NPI Number | 1790798684
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Entity Type | Organization
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Legal Business Name | BAJO DMD & LIWANAG DMD INC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 144 WEST CARSON ST
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City | CARSON
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State | CA
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Zip | 90745
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Country | US
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Telephone | 310-835-4088
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Fax | 310-835-8488
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Provider Business Mailing Address
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Address Line | 144 WEST CARSON ST
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City | CARSON
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State | CA
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Zip | 90745
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Country | US
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Telephone | 310-835-4088
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Fax | 310-835-8488
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Authorized Official
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Title or Position | DR VP
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Name | DR. ELENITA B LIWANAG
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Credential | DMD
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Telephone | 310-835-7088
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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 | 38963
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 38027
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License Number State | CA
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