MEDICARE: ENRIQUE ARGUETA DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1437743846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRIQUE ARGUETA DDS INC

Provider Business Mailing Address
First Line	:	6114 YORK BLVD STE C
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2593
Country	:	US
Telephone Number	:	323-982-9017
Fax Number	:

Provider Business Practice Location Address
First Line	:	6114 YORK BLVD STE C
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2593
Country	:	US
Telephone Number	:	323-982-9017
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	STEVE UMANA
Credential	:
Telephone Number	:	323-982-9017

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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