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Organization
MARSHA MOUTON DDS, INC
Active
Organization
MARSHA MOUTON DDS, INC
Active
Other names
La Tijera Dental Professionals
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARSHA MOUTON DDS (OWNER)
(310) 256-4326
Entity
Organization
Contact information
Practice address
6820 LATIJERA BLVD, SUITE # 205, LOS ANGELES, CA 90045
(310) 256-4326
Mailing address
6820 LATIJERA BLVD, SUITE # 205, LOS ANGELES, CA 90045
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
40688
CA
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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