Provider Demographics
NPI:1174777635
Name:PANTOJA, LILIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 N FAIR OAKS AVE
Mailing Address - Street 2:G100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1620
Mailing Address - Country:US
Mailing Address - Phone:626-398-5970
Mailing Address - Fax:626-398-6144
Practice Address - Street 1:1855 N FAIR OAKS AVE
Practice Address - Street 2:G100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-398-5970
Practice Address - Fax:626-398-6144
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice