Provider Demographics
NPI:1194108753
Name:BEAVERLY GRACE M. CATALAN DMD INC
Entity type:Organization
Organization Name:BEAVERLY GRACE M. CATALAN DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAVERLY
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:CATALAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-373-9522
Mailing Address - Street 1:22759 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3613
Mailing Address - Country:US
Mailing Address - Phone:310-373-9522
Mailing Address - Fax:310-373-8104
Practice Address - Street 1:22759 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3613
Practice Address - Country:US
Practice Address - Phone:310-373-9522
Practice Address - Fax:310-373-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty