Provider Demographics
NPI:1679893556
Name:ROSE JOY ENDONILA DDS,PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ROSE JOY ENDONILA DDS,PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ENDONILA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-671-9177
Mailing Address - Street 1:91 GREGORY LN
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4981
Mailing Address - Country:US
Mailing Address - Phone:925-671-9177
Mailing Address - Fax:925-726-2479
Practice Address - Street 1:91 GREGORY LN
Practice Address - Street 2:SUITE 9
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4981
Practice Address - Country:US
Practice Address - Phone:925-671-9177
Practice Address - Fax:925-726-2479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSE JOY ENDONILA DDS,PROFESIONAL DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty