Provider Demographics
NPI:1699164194
Name:PAGATPATAN, LUDIVINA LUIS (DDS)
Entity type:Individual
Prefix:MRS
First Name:LUDIVINA
Middle Name:LUIS
Last Name:PAGATPATAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 W ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3210
Mailing Address - Country:US
Mailing Address - Phone:310-303-3988
Mailing Address - Fax:310-303-3919
Practice Address - Street 1:3949 W 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
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice