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General NPI Number Information
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NPI Number | 1972900736
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Entity Type | Organization
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Legal Business Name | CAROLYN CANCIO DDS INC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE SUITE 801
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City | LOS ANGELES
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State | CA
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Zip | 90027-6005
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Country | US
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Telephone | 323-661-8001
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Fax | 323-661-8009
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Provider Business Mailing Address
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Address Line | 1300 N VERMONT AVE SUITE 801
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City | LOS ANGELES
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State | CA
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Zip | 90027-6005
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Country | US
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Telephone | 323-661-8001
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Fax | 323-661-8009
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROLYN CANCIO
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Credential | DDS
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Telephone | 323-661-8001
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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 | 42282
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License Number State | CA
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