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Organization
M.G. PROFESSIONAL DENTAL CORPORATION
Active
Organization
M.G. PROFESSIONAL DENTAL CORPORATION
Active
Other names
MGR DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MAYRA SANCHEZ (CEO)
(626) 274-0732
Entity
Organization
Contact information
Practice address
525 S. AZUSA WAY, LA PUENTE, CA 91744
(626) 810-0045
Mailing address
525 S. AZUSA WAY, LA PUENTE, CA 91744
(626) 810-0045
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
46945
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G92678-01
DENTICAL PROVIDER
CA
Enumeration date
08/17/2007
Last updated
08/17/2007
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