Provider Demographics
NPI:1679966055
Name:RAMIL C. BAUTISTA D.D.S.,INC.
Entity type:Organization
Organization Name:RAMIL C. BAUTISTA D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-423-7286
Mailing Address - Street 1:4837 HUNTINGTON DR N
Mailing Address - Street 2:STE.8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1981
Mailing Address - Country:US
Mailing Address - Phone:323-223-7200
Mailing Address - Fax:323-223-7500
Practice Address - Street 1:4837 HUNTINGTON DR N
Practice Address - Street 2:STE.8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1981
Practice Address - Country:US
Practice Address - Phone:323-223-7200
Practice Address - Fax:323-223-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487783700Medicare UPIN