Provider Demographics
NPI:1194122358
Name:LUDIVINA L PAGATPATAN,D.D.S.,INC.
Entity type:Organization
Organization Name:LUDIVINA L PAGATPATAN,D.D.S.,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUDIVINA
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:PAGATPATAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-303-3988
Mailing Address - Street 1:211 PISMO DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4740
Mailing Address - Country:US
Mailing Address - Phone:310-952-0895
Mailing Address - Fax:
Practice Address - Street 1:3949 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3210
Practice Address - Country:US
Practice Address - Phone:310-303-3988
Practice Address - Fax:310-303-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty