Provider Demographics
NPI:1962560623
Name:JAVIER REINALDO BUENDIA DDS INC
Entity type:Organization
Organization Name:JAVIER REINALDO BUENDIA DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:REINALDO
Authorized Official - Last Name:BUENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-582-4600
Mailing Address - Street 1:2521 E FLORENCE AVE
Mailing Address - Street 2:B-2
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4755
Mailing Address - Country:US
Mailing Address - Phone:323-582-4600
Mailing Address - Fax:323-582-4611
Practice Address - Street 1:2521 E FLORENCE AVE
Practice Address - Street 2:B-2
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4755
Practice Address - Country:US
Practice Address - Phone:323-582-4600
Practice Address - Fax:323-582-4611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAVIER REINALDO BUENDIA DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty