Licauco Tan Dental Corp

NPI #1952431033 in La Palma, California

Provider Information

NPI Number: 1952431033
Entity Type: Organization
Organization Name: Licauco Tan Dental Corp
Primary Specialty: Dentist
Enumeration Date: Mar 7, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 30 CENTERPOINTE DR
Address 2: SUITE 10
City: La Palma
State: California
ZIP Code: 90623-1055
Phone: (714) 994-0888

Authorized Official

Name: DR. CECILE LICAUCO, D.D.S.
Title: PRESIDENT
Phone: (714) 994-0888

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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