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Organization
UNTALAN DENTAL CORPORATION
Active
Organization
UNTALAN DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARISE R UNTALAN II (VP)
(213) 385-3828
Entity
Organization
Contact information
Practice address
10750 GLENOAKS BLVD, SUITE 6, PACOIMA, CA 91331-1690
(818) 686-1400
(818) 686-1411
Mailing address
10750 GLENOAKS BLVD, SUITE 6, PACOIMA, CA 91331-1690
(818) 686-1400
(818) 686-1411
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49693
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
249693
DELTA DENTAL ID NUMB
CA
01
—
G9241202
DENTICAL PROV NUMBER
CA
Enumeration date
03/22/2007
Last updated
08/22/2020
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