1124162987 NPI number — BEVERLY HILLS DENTAL CARE

Table of content: (NPI 1124162987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124162987 NPI number — BEVERLY HILLS DENTAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEVERLY HILLS DENTAL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124162987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5253 NEWCASTLE AVE
Provider Second Line Business Mailing Address:
#1
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-342-6686
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9025 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
#305
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-859-2432
Provider Business Practice Location Address Fax Number:
310-859-2467
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KESELBRENER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
RUVUN
Authorized Official Title or Position:
DDS
Authorized Official Telephone Number:
310-859-2432

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  45887 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com