Provider Demographics
NPI:1154335859
Name:ANTOLIN, RITA MARIANO (DDS)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIANO
Last Name:ANTOLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17346 CHATSWORTH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5714
Mailing Address - Country:US
Mailing Address - Phone:818-368-2215
Mailing Address - Fax:
Practice Address - Street 1:14712 PARTHENIA ST STE E
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2992
Practice Address - Country:US
Practice Address - Phone:818-830-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice