Provider Demographics
NPI:1699970848
Name:CLINICA DENTAL FAMILIAR SEVILLE
Entity type:Organization
Organization Name:CLINICA DENTAL FAMILIAR SEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:RAMIRO
Authorized Official - Last Name:TRIGOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-581-1010
Mailing Address - Street 1:6615 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4801
Mailing Address - Country:US
Mailing Address - Phone:323-581-1010
Mailing Address - Fax:323-581-7598
Practice Address - Street 1:6615 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4801
Practice Address - Country:US
Practice Address - Phone:323-581-1010
Practice Address - Fax:323-581-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41686261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-9245702OtherDENTICAL