Organization
FAISON & FAISON A PROFESSIONAL DENTAL CORPORATION
Active
Other names
St Francis Hospital Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALPHONSO FAISON DDS (CORPORATION SECRETARY)
(310) 537-2217
Entity
Organization
Contact information
Practice address
411 S LONG BEACH BLVD, COMPTON, CA 90221-3427
(310) 537-2217
(310) 537-8062
Mailing address
411 S LONG BEACH BLVD, COMPTON, CA 90221-3427
(310) 537-2217
(310) 537-8062
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
25252
CA
1223P0221X
Pediatric Dentistry
37330
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B2525202
DENTI-CAL
CA
Enumeration date
08/25/2005
Last updated
08/22/2020
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