Provider Demographics
NPI:1447095690
Name:MONROVIA 858 LLC
Entity type:Organization
Organization Name:MONROVIA 858 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE CONSUTANT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SAVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-987-1771
Mailing Address - Street 1:858 W FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1998
Mailing Address - Country:US
Mailing Address - Phone:818-987-1771
Mailing Address - Fax:
Practice Address - Street 1:858 W FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-1998
Practice Address - Country:US
Practice Address - Phone:818-987-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty