Enoma Alade, DDS MPH
Individual provider Active NPI Dentist · Azusa, CA
NPI 1831207240 · NPPES record last updated Jan 8, 2010
Key facts
- NPI
- 1831207240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 47979 (CA)
- Practice address
- 706 North Azusa Avenue
Azusa, CA 91702 - Phone
- (626) 334-7310
- Fax
- (626) 334-7311
- NPI assigned
- Aug 26, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47979 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter Luu DDS Inc | Past |
Accepting new patients | |
| Enoma Alade, DDS, Inc | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 47979 | CA | Yes |
Addresses
Primary practice location
706 North Azusa Avenue
Azusa, CA 91702
Mailing address
706 North Azusa Avenue
Azusa, CA 91702
Phone (626) 334-7310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G933866-01 | Medicaid | CA |
Other providers in Azusa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.