Individual
DR. CHARISE RUBY UNTALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
730 S WESTERN AVE STE 202, LOS ANGELES, CA 90005-5901
(213) 385-3828
(213) 385-2144
Mailing address
5009 ALTA CANYADA RD, LA CANADA, CA 91011-1716
(818) 952-2630
(213) 385-2144
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49984
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9241201
—
CA
Enumeration date
12/26/2006
Last updated
07/09/2007
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