| Anatoly Vaisan Dds Inc | |
|
11273 Laurel Canyon Blvd Suite#3 San Fernando CA 91340-4300 | |
| (818) 365-7191 | |
| (818) 361-7641 |
| Full Name | Anatoly Vaisan Dds Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11273 Laurel Canyon Blvd, San Fernando, California |
| Authorized Official Name and Position | Anatoly Vaisman (OWNER/DENTIST) |
| Authorized Official Contact | 8183657191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anatoly Vaisan Dds Inc 11273 Laurel Canyon Blvd Suite#3 San Fernando CA 91340-4300 Ph: (818) 365-7191 | Anatoly Vaisan Dds Inc 11273 Laurel Canyon Blvd Suite#3 San Fernando CA 91340-4300 Ph: (818) 365-7191 |
| NPI Number | 1023166600 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 10/23/2017 |
| Medicare PECOS PAC ID | 8123392347 |
|---|---|
| Medicare Enrollment ID | O20180719003508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023166600 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 88476-48 (California) | Primary |
| Provider Name | Anatoly Vaisman |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1619025277 PECOS PAC ID: 9032483250 Enrollment ID: I20180719003555 |
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