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Provider Information for 1780893222

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1780893222

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1780893222
Enumeration Date 2007-05-22
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 104 SATINWOOD AVE
OAK PARK, CA 91377-1244
United States

Phone: 818-991-5182 | Fax: 818-991-8863
View Map External Link
Primary Practice Address 23695 CALABASAS RD
CALABASAS, CA 91302-1502
United States

Phone: 818-591-2480 | Fax: 818-591-7599
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 28443