Provider Demographics
NPI:1245040617
Name:R CAZALI DDS DENTAL CORPORATION INC.
Entity type:Organization
Organization Name:R CAZALI DDS DENTAL CORPORATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-919-2315
Mailing Address - Street 1:1431 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1133
Mailing Address - Country:US
Mailing Address - Phone:626-919-2315
Mailing Address - Fax:
Practice Address - Street 1:1431 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1133
Practice Address - Country:US
Practice Address - Phone:626-919-2315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental