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12930 Ventura Blvd Ste 226c Studio City CA 91604-2200 | |
| (818) 465-7545 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12930 Ventura Blvd Ste 226c, Studio City, California |
| Authorized Official Name and Position | Michael Lasky (OWNER) |
| Authorized Official Contact | 8184657545 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12930 Ventura Blvd Ste 226c Studio City CA 91604-2200 Ph: (818) 465-7545 | 12930 Ventura Blvd Ste 226c Studio City CA 91604-2200 Ph: (818) 465-7545 |
| NPI Number | 1588372700 |
|---|---|
| Provider Enumeration Date | 11/07/2022 |
| Last Update Date | 11/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588372700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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