| Jonathan Shadi, Dds, Inc | |
|
12300 Wilshire Blvd Suite #326 Los Angeles CA 90025-1020 | |
| (310) 652-6553 | |
| (310) 652-6553 |
| Full Name | Jonathan Shadi, Dds, Inc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 12300 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Jonathan Shadi (PRESIDENT) |
| Authorized Official Contact | 3106526553 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan Shadi, Dds, Inc 12300 Wilshire Blvd Suite #326 Los Angeles CA 90025-1020 Ph: (310) 652-6553 | Jonathan Shadi, Dds, Inc 12300 Wilshire Blvd Suite #326 Los Angeles CA 90025-1020 Ph: (310) 652-6553 |
| NPI Number | 1205370319 |
|---|---|
| Provider Enumeration Date | 12/08/2016 |
| Last Update Date | 12/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205370319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 58812 (California) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 63560 (California) | Primary |
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