Organization
ILAGAN DENTAL CORP.
Active
Other names
Tooth Fairy Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA ELOISA ILAGAN D.D.S (OWNER/DENTIST)
(818) 365-3004
Entity
Organization
Contact information
Practice address
556 S BRAND BLVD, SAN FERNANDO, CA 91340-4002
(818) 365-3004
(818) 365-7100
Mailing address
556 S BRAND BLVD, SAN FERNANDO, CA 91340-4002
(818) 365-3004
(818) 365-7100
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
46831
CA
Other
Enumeration date
04/20/2010
Last updated
04/20/2010
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