Provider Demographics
NPI:1447441597
Name:GERTRUDE M. PECAOCO DENTAL CORP.
Entity type:Organization
Organization Name:GERTRUDE M. PECAOCO DENTAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ESPANOLA
Authorized Official - Last Name:PECAOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-413-3910
Mailing Address - Street 1:1925 W TEMPLE ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4970
Mailing Address - Country:US
Mailing Address - Phone:213-413-3910
Mailing Address - Fax:213-413-4078
Practice Address - Street 1:1925 W TEMPLE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4970
Practice Address - Country:US
Practice Address - Phone:213-413-3910
Practice Address - Fax:213-413-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty