Provider Demographics
NPI:1063559573
Name:PALAGANAS, SEVERINO BARTOLOME JR (DDS)
Entity type:Individual
Prefix:DR
First Name:SEVERINO
Middle Name:BARTOLOME
Last Name:PALAGANAS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 EAGLE ROCK BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3243
Mailing Address - Country:US
Mailing Address - Phone:323-717-9063
Mailing Address - Fax:
Practice Address - Street 1:2023 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2417
Practice Address - Country:US
Practice Address - Phone:213-353-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice