Organization
RITA T. DERAGOBIAN DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RITA DERAGOBIAN DDS (DENTIST/OWNER)
(626) 914-3900
Entity
Organization
Contact information
Practice address
1435 E ROUTE 66 STE D, GLENDORA, CA 91740-3748
(626) 914-3900
(626) 914-0019
Mailing address
1435 E ROUTE 66 STE D, GLENDORA, CA 91740-3748
(626) 914-3900
(626) 914-0019
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QD0000X
Dental Clinic/Center
55480
CA
Other
Enumeration date
06/05/2018
Last updated
01/08/2020
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