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Organization
LICAUCO TAN DENTAL CORP
Active
Organization
LICAUCO TAN DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CECILE LICAUCO D.D.S. (PRESIDENT)
(714) 994-0888
Entity
Organization
Contact information
Practice address
30 CENTERPOINTE DR, SUITE 10, LA PALMA, CA 90623-1055
(714) 994-0888
(714) 994-6038
Mailing address
30 CENTERPOINTE DR, SUITE 10, LA PALMA, CA 90623-1055
(714) 994-0888
(714) 994-6038
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
40656
CA
122300000X
Dentist
41314
CA
Other
Enumeration date
03/07/2007
Last updated
08/22/2020
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