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RAFAEL ALBERTO ANTILLON DDS
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1760693329
Individual Registrant: RAFAEL ALBERTO ANTILLON DDS
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
3516 MARTIN LUTHER KING BLVD SUITE 7 LYNWOOD, CA 90262 US
Tel: 310-639-7224 Fax: 310-639-3939
Tel: 310-639-7224 Fax: 310-639-3939
Contact information for business:
3516 MARTIN LUTHER KING BLVD SUITE 7 LYNWOOD, CA 90262 US
Tel: 310-639-7224 Fax: 310-639-3939
Tel: 310-639-7224 Fax: 310-639-3939
Registration Information:
NPI: 1760693329
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | CA | 39747 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
