Provider Demographics
NPI:1588419170
Name:COUTO DENTAL GROUP
Entity type:Organization
Organization Name:COUTO DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-634-5137
Mailing Address - Street 1:8839E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1713
Mailing Address - Country:US
Mailing Address - Phone:626-949-0295
Mailing Address - Fax:
Practice Address - Street 1:8839E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1713
Practice Address - Country:US
Practice Address - Phone:626-949-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUTO DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental