Provider Demographics
NPI:1285957712
Name:ENOMA ALADE, DDS, INC
Entity type:Organization
Organization Name:ENOMA ALADE, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ENOMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:626-334-7310
Mailing Address - Street 1:706 NORTH AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2507
Mailing Address - Country:US
Mailing Address - Phone:626-334-7310
Mailing Address - Fax:626-334-7311
Practice Address - Street 1:706 NORTH AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2507
Practice Address - Country:US
Practice Address - Phone:626-334-7310
Practice Address - Fax:626-334-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG933866-01Medicaid