Provider Demographics
NPI:1215303425
Name:EMALYN SANGA-FORBES, D.D.S., INC.
Entity type:Organization
Organization Name:EMALYN SANGA-FORBES, D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMALYN
Authorized Official - Middle Name:BERNABE
Authorized Official - Last Name:SANGA-FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-779-2120
Mailing Address - Street 1:14649 VICTORY BLVD
Mailing Address - Street 2:SUITE #21
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4187
Mailing Address - Country:US
Mailing Address - Phone:818-779-2120
Mailing Address - Fax:818-779-2138
Practice Address - Street 1:14649 VICTORY BLVD
Practice Address - Street 2:SUITE #21
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-4187
Practice Address - Country:US
Practice Address - Phone:818-779-2120
Practice Address - Fax:818-779-2138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMALYN SANGA-FORBES, D.D.S., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental