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General NPI Number Information
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NPI Number | 1962001347
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Entity Type | Organization
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Legal Business Name | MARIDETTE CUNANAN DDS INC
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Dates
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Enumeration Date | 10/18/2020
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Last Update Date | 10/18/2020
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Provider Practice Location Address
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Address Line | 3731 WILSHIRE BLVD STE 625
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City | LOS ANGELES
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State | CA
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Zip | 90010-2824
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Country | US
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Telephone | 213-381-3738
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Fax |
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Provider Business Mailing Address
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Address Line | 5333 LEMON GROVE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-4005
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Country | US
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Telephone | 360-990-1034
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Fax |
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DR. MARIDETTE CUNANAN
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Credential | DDS
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Telephone | 360-990-1034
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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 |
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License Number State |
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