| Gottschalk And Lee Dental Corp. | |
|
5620 Wilbur Ave. Suite 319 Tarzana CA 91356-1351 | |
| (818) 344-4210 | |
| (818) 344-4093 |
| Full Name | Gottschalk And Lee Dental Corp. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5620 Wilbur Ave. Suite 319, Tarzana, California |
| Authorized Official Name and Position | Kenneth Kianfu Lee (OWNER) |
| Authorized Official Contact | 8183444210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gottschalk And Lee Dental Corp. 5620 Wilbur Ave. Suite 319 Tarzana CA 91356-1351 Ph: (818) 344-4210 | Gottschalk And Lee Dental Corp. 5620 Wilbur Ave. Suite 319 Tarzana CA 91356-1351 Ph: (818) 344-4210 |
| NPI Number | 1104088160 |
|---|---|
| Provider Enumeration Date | 06/30/2008 |
| Last Update Date | 06/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104088160 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | SUR01353F (California) | Primary |
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