NPIMap

Organization Active NPI

Licauco Tan Dental Corp

  • Dentist
  • La Palma, CA
National Provider Identifier
1952431033
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
40656 Issued in CA
Legal business name
LICAUCO TAN DENTAL CORP
Practice address
30 Centerpointe Dr
Suite 10
La Palma, CA 90623-1055
Phone
(714) 994-0888
Fax
(714) 994-6038
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cecile Licauco, D.D.S.
Title
President
Phone
(714) 994-0888

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 40656 CA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 41314 CA

Addresses

Primary practice location

30 Centerpointe Dr
Suite 10
La Palma, CA 90623-1055

Mailing address

30 Centerpointe Dr
Suite 10
La Palma, CA 90623-1055
Phone (714) 994-0888

National Provider Directory

National Provider Directory
Tax ID family
Licauco Tan Dental Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

30 Centerpointe Dr
Ste 10
La Palma, CA 90623
Phone (714) 994-0888

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952431033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CENTERPOINTE DR",
            "address_2": "SUITE 10",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "906231055",
            "telephone_number": "714-994-0888",
            "fax_number": "714-994-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CENTERPOINTE DR",
            "address_2": "SUITE 10",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "906231055",
            "telephone_number": "714-994-0888",
            "fax_number": "714-994-6038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICAUCO TAN DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LICAUCO",
        "authorized_official_first_name": "CECILE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-994-0888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "40656",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "41314",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Palma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.