| |
11300 Magnolia Blvd Suite 5 North Hollywood CA 91601-3772 | |
(818) 980-7222 | |
(818) 508-1770 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 11300 Magnolia Blvd, North Hollywood, California |
Authorized Official Name and Position | Aleksey Fuks (OWNER) |
Authorized Official Contact | 8189807222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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11300 Magnolia Blvd Suite 5 North Hollywood CA 91601-3772 Ph: (818) 980-7222 | 11300 Magnolia Blvd Suite 5 North Hollywood CA 91601-3772 Ph: (818) 980-7222 |
NPI Number | 1720106982 |
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Provider Enumeration Date | 03/27/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720106982 | NPI | - | NPPES |
G89900-01 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 42547 (California) | Primary |
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