| Eugene A Goncharov Dds Inc | |
|
6221 Wilshire Blvd Ste 303 Los Angeles CA 90048 | |
| (323) 931-2000 | |
| (323) 634-9341 |
| Full Name | Eugene A Goncharov Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 6221 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Eugene A Goncharov (OWNER) |
| Authorized Official Contact | 3239312000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eugene A Goncharov Dds Inc 6221 Wilshire Bl Ste 303 Los Angeles CA 90048 Ph: (323) 931-2000 | Eugene A Goncharov Dds Inc 6221 Wilshire Blvd Ste 303 Los Angeles CA 90048 Ph: (323) 931-2000 |
| NPI Number | 1831251685 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831251685 | NPI | - | NPPES |
| 040823 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 40823 (California) | Primary |
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