Provider Demographics
NPI:1588981229
Name:ILAGAN DENTAL CORP.
Entity type:Organization
Organization Name:ILAGAN DENTAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELOISA
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-365-3004
Mailing Address - Street 1:556 S BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4002
Mailing Address - Country:US
Mailing Address - Phone:818-365-3004
Mailing Address - Fax:818-365-7100
Practice Address - Street 1:556 S BRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4002
Practice Address - Country:US
Practice Address - Phone:818-365-3004
Practice Address - Fax:818-365-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46831302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization