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Organization
GONZALO ECHARTE PROFESSIONAL DENTAL CORPORATION
Active
Organization
GONZALO ECHARTE PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GONZALO ECHARTE DDS (PRESIDENT)
(213) 483-1221
Entity
Organization
Contact information
Practice address
525 S ALVARADO ST, LOS ANGELES, CA 90057-2903
(212) 483-1221
Mailing address
525 S ALVARADO ST, LOS ANGELES, CA 90057-2903
(212) 483-1221
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
52379
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G93205
MEDICARE
CA
Enumeration date
11/14/2007
Last updated
11/14/2007
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