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DR. MINTRA TAN D.D.S.
Pediatric Dentistry >> Dentist >> Dental ProvidersRegistrant NPI Number: 1821249426
Individual Registrant:DR. MINTRA TAN D.D.S.
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
151 S MEDNIK AVE EAST LOS ANGELES, CA 90022-1606 US
Tel: 323-263-3303 Fax: --
Tel: 323-263-3303 Fax: --
Contact information for business:
151 S MEDNIK AVE EAST LOS ANGELES, CA 90022-1606 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1821249426
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223P0221X | Dental Providers Dentist Pediatric Dentistry | CA | 53108 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
