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JOHN R DAGOSTINO DDS
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1407912181
Individual Registrant: JOHN R DAGOSTINO DDS
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
15925 EAST GALE AVE SUITE C HACIENDA HIEGHTS, CA 91745 US
Tel: 626-336-6401 Fax: 626-336-5394
Tel: 626-336-6401 Fax: 626-336-5394
Contact information for business:
15925 EAST GALE AVE SUITE C HACIENDA HIEGHTS, CA 91745 US
Tel: 626-336-6401 Fax: 626-336-5394
Tel: 626-336-6401 Fax: 626-336-5394
Registration Information:
NPI: 1407912181
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | CA | 30427 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| MEDICAL # | B3042701 | CA | 01 |
